60 DR. YELLOLY'S REMARKS ON THE 



diseases has been nearly as great, during the first sixteen years of life, as in 

 the whole after period ; but if we take the cases afforded by Norwich and 

 London, independently of their respective country districts, as many cases of 

 calculus have occurred below 14, as above that age ; so that in those two in- 

 stances, the proportion of children affected with this complaint, (judging from 

 the hospital returns,) has been larger in a town, than in a country situation. 



With regard to the mortality from the operation of lithotomy, the number 

 of deaths in the Norfolk and Norwich Hospital, has been 89, which is a mor- 

 tality of 1 in 7-29 cases, from the institution of the charity. But it is credit- 

 able to the state of modern surgery, and to the skill of the present surgeons of 

 that Hospital, that in the operations performed by them (which amount to 

 near one third of the whole number from the commencement), the proportion 

 of deaths has been reduced to 1 in 8.42, which differs very little from the 

 average of Cheselden, M^hose improved lateral operation they follow*. 



afford their full complement of men to the Britisli navy, but have less tendency to calculous diseases, 

 according to our present evidence, than England ; it will not be found, even if we take the smaller 

 population of 1810, instead of that of 1820, that the proportion of those complaints, among large 

 bodies of natives of the three kingdoms, between 14 and 50 years of age, acting together, will differ 

 much from that stated by Mr. Hutchison. 



• Cheselden is generally considered as having lost only 1 patient in 10^, in his hospital lithotomy 

 practice ; but the summary referred to, of 20 deaths in 213 cases, applied only to the success of his 

 improved lateral operation. As far as existing documents afford evidence on the subject, (Anatomy, 

 book iv. chap. 6 ; and Treatise on the High Operation, p. 1 7), that great surgeon, who was distin- 

 guished for candour and ingenuousness, lost, previously, 8 cases out of 28, which raised the average 

 mortality of his hospital practice to 1 case in 8.6. His great success was in children ; for the state- 

 ment given by him, evinces his mortality to have been 1 in 5^, of even his most successful operations, 

 in persons above 14. I may likewise remark, that it was foreign to Cheselden's plan, to notice any 

 operations, but those immediately connected with his historical view of lithotomy ; and he did not 

 therefore record, in his publications, the number or result of any which occurred to him in St. 

 Thomas's Hospital, between the time of his appointment to that charity in 1718, and his first men- 

 tioned high operation in 1722. — It is also important to bear in mind, in referring to Cheseldek's 

 mortality, that some of the patients who were included among his successful cases, were carried off by 

 small-pox, in the Hospital, before their complete recovery. He gives it as his opinion, indeed, that 

 such deaths were not in greater proportion, than might be expected to have occurred from small -pox 

 alone ; and the well-known uprightness of his character, entitles this opinion to every degree of credit. 

 Hence, in strict correctness, they do not affect the accuracy of his general statement. In the Norfolk 

 and Norwich Hospital, however, it is the invariable practice, for no case to be put down as a recovery 

 from the stone operation, if the patient die in the hospital, of any disease which may even have come 

 on during his convalescence. 



