258 AROUND THE WORLD VIA INDIA. 



acid and urates) is probably one of the largest stones 

 ever removed from the human bladder. About half 

 of the stone is shown in the central compartment and 

 the fragments are grouped around it. The operation 

 in this case was performed in 1876 or 1877 by the late 

 Apothecary White at Tando Alyhar Dispensary, near 

 Hyderabad, in Sinde. The patient was a man 25 years 

 old and had suffered from symptoms of stone since 

 childhood. An attempt was made to extract it by the 

 lateral operation, but this being unsuccessful, the supra- 

 pubic operation was performed. Even now it was found 

 impossible to extract the stone. By means of some 

 improvised instrument (a craniotomy forceps), the 

 stone was broken in pieces and removed. The patient 

 lived for about twelve hours after the operation. The 

 weight of the stone was 30 ounces and 95 grains. 



Ainhum of the Small Toe. — This curious condition 

 generally commences on the inner and plantar surface 

 of the little toe. It begins as a narrow groove on the 

 skin, which slowly deepens. The groove involves the 

 whole circumference of the digit, the distal portion of 

 which swells up as if it had been constricted by a liga- 

 ture. The digital portion finally becomes a round, 

 dangling mass and after some years drops off. The 

 fourth toe is next affected, . and so on. 



Mycetoma or Madura Foot. — The shape of the foot 

 is characteristic (Fig. 50). The disease is absolutely 

 localized to the foot, the circumference of the leg above 

 the ankle not being increased. The skin of the foot is 

 covered with pellets, some of which have been cut across 

 to show the yellow fatty material of which they are 

 composed. A window has been cut on one side of the 

 foot. A capsule of thick, dense, fibrous tissue envelopes 

 the foot and this hardened tissue is honeycombed with 

 small cavities, which lodge the yellow bodies in the 

 interior of the bone, which has fallen away from the 

 tissues and which can be seen riddled with large com- 

 municating cavities. The specimen was obtained by 



