58 DR. YELLOLY'S REMARKS ON THE 



the calculation*. It would seem probable from this rough estimate, that 1 

 case of operation for calculus occurs annually for eveiy 38,000 inhabitants in 

 the metropolis, and about half that proportion in the counties contiguous to it. 



From the information which Mr. Smith has furnished, it appears that about 

 60 operations of lithotomy are performed annually in the provincial hospitals 

 of England. This estimate includes Wales, whose sick poor, when sent from 

 home, are chiefly transmitted to the hospitals of one or other of the adjoining 

 English counties, as there are no such charities in the principality. — Suffolk 

 did not possess a county hospital when Mr. Smith was prosecuting his re- 

 searches ; and consequently was not included in his calculations, except as 

 far as it fiirnished cases to the Norwich, or other hospitals. It possesses, 

 however, in an eminent degree, the calculous character of Norfolk ; and I have 

 been enabled, through the kindness of some professional friends, to estimate 

 the operations of lithotomy performed in it, by private practitioners, duiing 

 the last 20 years, as about 4 annually. If this number be added to 1 .26, (which 

 is the annual proportion of 73 admissions from Suffolk to the Norwich Hospital 

 in 56 years,) we shall have 5.26 cases as the annual product of Sufiblk on its 

 population of 234,000 ; or 1 case for eveiy 44,000 inhabitants. It may be re- 

 marked, that the want of an hospital in Suffolk, till within these few years, and 

 its distance, both from Norwich, and London, have occasioned the performance 

 of a much larger proportion of operations of lithotomy in that county, by private 

 practitioners, than is usual in other distiicts. 



According to Mr. Smith's calculation, there will therefore be 107 public 

 operations in the whole of England and Wales, which, with the addition of 4 

 from Suffolk, will make 111 operations annually, on a population of very 

 nearly 12,000,000, or 1 case for every 108,000 inhabitants. This, however, is 

 not quite a third of the proportion which occurs in Norfolk, 



If we put aside from the calculation, the 15f cases occurring in the Norfolk 

 district, (comprehending Norfolk and Suffolk) with its population, we shall 

 then have 1 calculous case for every 118,000 inhabitants, independently of that 



* Middlesex, Essex, Surrey, and Herts, may be regarded as hitherto principally dependent on the 

 metropolis for Hospital accommodation ; Kent, Sussex, Bucks, and Berks, as only partially so, per- 

 haps to half their demand. 



