62 



DR. YELLOLY'S REMARKS ON THE 



Tlie operation of lithotomy is always attended with more danger, when 

 calculi are large, than when they are small. This has been strikingly exem- 

 plified at Norwich ; for of 52 cases of adult males, in which calculi of 2oz. or 

 more occurred, 31 died, or nearly 2 in 3 ; while in 282 cases, also of adult 

 males, in which the stones weighed less than 2oz., the mortality only amounted 

 to 37, or rather less than 1 in 7- Part of this unfavourable issue, is no doubt 

 to be attributed to the injury, both local and constitutional, which the long 

 continuance of a large calculus in the bladder may occasion ; but, at the same 

 time, when we consider the general hazard of the operation of lithotomy, even 

 in the most skilful and experienced hands, and the injury produced by the force 

 necessary for extracting a calculus, and particularly a large one, there is a 

 strong inducement afforded, to the full and dispassionate examination of the 

 mechanical means which have been suggested, either for diminishing the 

 magnitude of calculi, during an operation, in the revived and improved me- 

 thod of Mr. Henry Earle *, or for wearing them down, by slow and gradual 

 detrition, according to the plan which has been employed at Paris by M. Civiale, 

 so as in many cases to do away with the necessity of the operation altogether -f*. 



The circumstances which occasion death after the operation of lithotomy, 

 form an important and interesting subject of investigation to the surgeon ; and 



* Med. Chir. Trans, vol. xi. p. 09. f Dela Lithotritie, ou Broiement de la Pierre dans la vessie. 



