64 DR. YELLOLY'S REMARKS ON THE 



of cystic oxide having a lithic nucleus, which was removed from a boy of 4 

 years old, and was followed, in a short time, by the formation of another of 

 fusible exterior, with a lithic interioi-, which made a second operation necessary 

 in less than a year from the first. So speedily may the character of the animal 

 process be changed, on which the formation or augmentation of urinary con- 

 cretions depends. 



With regard to the respective number of calculous cases which occur among 

 the lower and higher orders of society, it is necessarily very difficult to obtain 

 any correct information. Mr. Martineau, however, the senior surgeon of the 

 Norwich Hospital, one of the most eminent and successful lithotomists of the 

 present day, laid before the public, some years since, with much valuable in- 

 formation on the subject of lithotomy, a list of private patients, amounting to 

 10 in number, upon whom he operated, during a period that he operated on 

 111 public patients*. The proportion was 1 private patient to 11 public; 

 which differs not much from the results of the late Mr. Brandon Trve of 

 Glocester, as given in Mr. Smith's paper. 



I regret that but little advances have been made, in a knowledge of the 

 circumstances on which a tendency to calculous complaints depends ; and I 

 am not aware of such differences of air, water, soil, or habits of life having 

 yet been detected, as can justify us in attributing the prevalence of stone, in 

 the Norfolk district, to any of those causes. 



A constitutional predisposition to the occurrence of calculous diseases, un- 

 questionably exists in certain families. Dr. Prout, in his valuable work on 

 Urinary Diseases, mentions an instance of a calculous tendency in three con- 

 tinuous generations ; and I am acquainted with a family, where the grandfather, 

 a man of active habits living in the country, was twice cut for the stone, and 

 died from the second operation ; the father was also cut ; and two of the sons 

 have exhibited an unequivocal calculous disposition, from an early period of 

 life. I may also observe, that a few examples have occurred at the Norfolk 

 and Norwich Hospital, where more than one individual of a family has had 

 the disease, and undergone the operation. 



The large employment of ill fermented farinaceous food, which marks in 

 some degree the habits of the commonalty of Norfolk, may perhaps be regarded 



* On Lithotomy. Medico-Chirurgical Transactions, vol. xi. p. 402. 



