URINARY CALCULI. 



Returns of the cafes of lithotomy in the Norfolk and 

 Norwich hofpital, from 1772 to 1816, making a period of 

 forty-four years : 



It appears, fays Dr. Marcet, from the above table, that 

 the mean annual number of cafes of lithotomy in the 

 Norwich hofpital, during the laft forty-four years, has been 

 iii or 23 in every two years ; and that the total number 

 of fatal cafes in the 506 operations, is 70, or i in j^, or 4 

 in 29. It appears alfo, that the proportion of females who 

 have undergone the operation is to that of males, as 58 to 

 1000, or about i to 17 ; that the mortahty from the oper- 

 ation in children was only about i in 18 ; while, in adults, 

 it was 4 in 19, or nearly quadruple. 



From the year 1772 to 1816, the Norwich hofpital has 

 received 18,859 patients of all kinds, making an average of 

 428 annual admiflions ; and Dr. Marcet obferves, that the 

 proportion of 506 operations of lithotomy, out of 18,859 

 patients, which correfponds to about i in 38, exceeds, in an 

 aftonifhing degree, that obtained from any of the other pub- 

 lic inftitutions, vvhofe records he examined. 



Next to the records of the Norwich hofpital. Dr. Marcet 

 derived the moft diftinft information of this kind from Che- 

 felden, who mentions in his work on anatomy, that, during 

 the courfe of his public praftice in St. Thomas's hofpital, a 

 period of about twenty years, he had performed the oper- 

 ation of the ftone 213 times, and loft only 20 patients. 

 This was about 2 cafes in 21, which is much lefs than the 

 common average. 



In St. Thomas's hofpital, during the laft ten years, the 

 operation of lithotomy feems to have been done, on an 

 average, 1 1 times in each two years ; and i cafe of ftone has 

 occurred in each 528 patients admitted. 



In St. Bartholomew's, lithotomy was performed 56 times 

 in the years 18 12, 18 13, 18 14, 181 5, and 1816. The an- 

 nual average about 1 1 , or i in each 340 patients of all 

 defcriptions. 



In Guy's hofpital. Dr. Marcet has reafon to believe that 

 lithotomy has been performed, on an average, about 9 or 10 

 times annually, during the laft 20 or 30 years. The pro- 

 portion of calculous patients there is alfo eftimated at i in 

 about 300 cafes of all kinds. 



Dr. Marcet's inquiries incline him to think, that, on the 

 whole, the occurrence of hthotomy in the London hofpitals 

 has for fome years been gradually diminiftiing ; and this he 

 conceives may be owing partly to a real retluftion in the 

 frequency of the ftone, from fome alteration in the diet or 

 habits of the people ; partly to the ufe of appropriate medi- 

 cines ; and partly to the circumftance of calculous patients 

 not reforting fo exclufively, as was formerly the cafe, to 

 the great London hofpitals for the operation. 



In the Royal Infirmary at Edinburgh, the average 

 number of ftone cafes annually, during the laft fix years, is 

 (aid not to have exceeded two, although about 2000 patients 

 aft admitted there every year. 



Dr. Marcet has been informed by M. Roux, that in La 

 Charite, at Paris, ten or twelve cafes of ftone occur every 

 year out of about 2600 patients ; and that the proportion 

 of deaths from the operation there is i in 5 or 6. 



In the H6pital des Enfans Malades, in the fame city, 

 Dr. Marcet ftates, on the authority of Dr. Biett, that about 

 lis cafes of ftone are received every year into that eftablifti- 

 ment, where about 3000 children of both fexes are annually 

 admitted. There have been only three cafes in females, 

 and, what is remarkable, only two deaths from the opera- 

 tion, in the courfe of the laft feven years. 



Dr. M-ircet has been acquainted, that at Vienna litho- 

 tomy is comparatively rare, not on account of the want of 

 good furgeons, or the unfrequent occurrence of ftone cafes 

 in that part of the continent, but in confequence of the little 

 attention paid to this difeafe by the moft eminent furgeons 

 of the Auftrian capital. It is certainly no cr.-dit to thefe 

 praftitioners, to find them encouraging Pajola's plan of 

 operating, which is a revival of one form of that barbarous 

 method, the apparatus major. The fuccefs w'nich this litho- 

 tomift is faid to have had is almoft incredible, when his way 

 of operating is confidered ; for he is ftated to have per- 

 formed the operation 550 times with fuccefs. 



At Geneva, fays Dr. Marcet, in a population of 30,000 

 fouls, lithotomy, including both public and private pradlice, 

 has been performed only thirteen times in the laft twenty 

 years, though good furgeons are never wanting in that town 

 to perform the operation, when an opportunity occurs. 

 Out of thefe thirteen patients, feven were not ftriftly 

 Genevefe, though belonging to the neighbouring diftricts, 

 and one was an Englifliman ; fo that the difeafe would, at 

 firft fight, appear to be a rare occurrence at Geneva. But, 

 continues Dr. Marcet, if the fraallnefs of the Genevefe po- 

 pulation be taken into account, this proportion of calculous 

 cafes may not fall very (liort of that obferved in other 

 places. At Lyons, a populous town, which is not more 

 than 80 miles diftant from Geneva, the difeafe is ftated to 

 be rather frequent. 



In tropical climates, urinary calculi are almoft unknown ; 

 and, as Dr. Marcet obferves, we have, in confirmation of 

 this Angular and important fatl, the recent ilatenient of Dr. 

 Scott, who, from his long refidence in India, and his well- 

 known habits of obfervation, may be confidered as one of 

 the beft authorities. Dr. Scott indeed affirms, that, be- 

 tween the tropics, he ne%'er met with a fingle inftance of th« 

 formation of a ftone in the urinary bladder, although he 

 knew of fome cafes which had been imported, and which 

 were not cured by climate. See Marcet's Eftay on the 

 Cliemical Hiftory and Medical Treatment of Calculous 

 Diforders, chap. 2. London, 1817. 



Urinary calculi are faid alfo to be very uncommon in 

 Spain and Africa. If, however, it be an undoubted faft, 

 that the diforder is rare in hot climates, ftill it is impoffible 

 to offer any rational theory of the circumftance, becaufe 

 the difeafe is likewife unufual in very cold countries, fuch 

 as Sweden. See Richerand's Nofographie Chir. torn. iii. 

 p. 528. edit. 4. 



With regard to the chemical nature of urinary calculi, 

 there was nothing known until as late a period as 1776, 

 vi'hen the celebrated Swedilh chemift, Scheele, publifhed a 

 paper on the fubjeft, in the Stockholm Tranfattions. In 

 this effay, he ftated, that all the urinary calculi which he 

 had examined, confifted of a pecuhar concrete fubftance, 

 now well known by the name of the lithic or uric acid, 

 which he alfo ftiewed was foluble in alkaline hxivia. Scheele 

 further difcovered, that the lithic matter was in fome degree 



capable 



