TENDENCY TO CALCULOUS DISEASES. 63 



I am inclined to think, that in addition to the unforeseen and unavoidable 

 occurrences, M^hich sometimes succeed the very best exertions of surgical skill, 

 there is something to be attributed to the constitutional shock of a great ope- 

 ration, under which the system will occasionally sink. It is, however, a con- 

 sideration, that may abate undue confidence from early success, on the one 

 hand, and offer consolation and encouragement, under unexpected failures, on 

 the other, that of two of the most distinguished contemporary lithotomists of 

 this country, whose qualifications were of the most respectable kind, one lost 

 3 patients only of his first 50 operations, or 1 in 16|; and 1 in 4| of the re- 

 mainder, amounting to more than double, so as to reduce his average mortality 

 to rather below 1 in 7 ; while the other lost 11 of his first 50 patients, or 1 in 4^ ; 

 and in his remaining cases, which a good deal exceeded those in the former 

 instance, lost only I in I3f , so as to render his whole average mortality rather 

 less than 1 in 8*. 



Recurrences of stone seem to be not very frequent ; 14 instances, or 1 in 46 

 only, being found in the records of the Norfolk and Norwich Hospital, of the 

 operation having been performed twice on the same individual : 3 were below 

 14, and 9, (of whom 2 died) above that age. The production of the second 

 calculus took place, in 4 of these cases, within 1 year ; in 5, within 2 years ; 

 in 3, within 3 years ; while in the 2 remaining cases, the operation did not 

 become again necessary, till after a lapse, respectively, of 7 and 10 years. 



It does not appear that a second calculus is necessarily of the same charac- 

 ter as the first. In the child from whom the first known specimen of cystic 

 oxide was extracted, (that analysed by Dr. Wollaston), the disease returned ; 

 but a second operation was not submitted to. The child died, when a calculus, 

 of a different character from the original one, was found in the bladder. 



A curious example, of a similar kind, was shown to me at Cambridge, by 

 Mr. John Okes, one of the surgeons to the Cambridge Hospital, of a calculus 



* The examples occurred in the Norfolk and Norwich Hospital ; and the gentlemen alluded to, 

 were tlie late Dr. Rigby (formerly senior surgeon to that establishment), and the late Mr. Martineau. 

 — I lament to say, that the death of the latter gentleman has taken place since my paper was laid 

 before the Society. — The whole number of Dr. Rigby's hospital operations was 106, with 15 deaths; 

 and of Mr. Martineau's 147, with 17 deaths. Mr. Martineau dated his principal success 

 (Medico-Chir. Trans, vol. xi. p. 402.) from the time that he employed the blunt gorget, according to 

 Cheselden's method; Dr. Rigby, as far as I have had an opportunity of ascertaining the point, 

 always used the blunt gorget. 



