58 
DR. YELLOLY’S REMARKS ON THE 
the calculation*. It would seem probable from this rough estimate, that 1 
case of operation for calculus occurs annually for every 38,000 inhabitants in 
tiie metropolis, and about half that proportion in the counties contiguous to it. 
From the information which Mr. Smith has furnished, it appears that about 
60 operations of lithotomy are performed annually in the provincial hospitals 
of England. This estimate includes Wales, whose sick poor, when sent from 
home, are chiefly transmitted to the hospitals of one or other of the adjoining 
English counties, as there are no such charities in the principality. — Suffolk 
did not possess a county hospital when Mr. Smith was prosecuting his re- 
searches ; and consequently was not included in his calculations, except as 
far as it furnished cases to the Norwich, or other hospitals. It possesses, 
however, in an eminent degree, the calculous character of Norfolk ; and I have 
been enabled, through the kindness of some professional friends, to estimate 
the operations of lithotomy performed in it, by private practitioners, during 
the last 20 years, as about 4 annually. If this number be added to 1.26, (which 
is the annual proportion of 73 admissions from Suffolk to the Norwich Hospital 
in 56 years,) we shall have 5.26 cases as the annual product of Suffolk on its 
population of 234,000 ; or 1 case for every 44,000 inhabitants. It may be re- 
marked, that the want of an hospital in Suffolk, till within these few years, and 
its distance, both from Norwich, and London, have occasioned the performance 
of a much larger proportion of operations of lithotomy in that county, by private 
practitioners, than is usual in other districts. 
According to Mr. Smith’s calculation, there will therefore be 107 public 
operations in the whole of England and Wales, which, with the addition of 4 
from Suffolk, will make 111 operations annually, on a population of very 
nearly 12,000,000, or 1 case for every 108,000 inhabitants. This, however, is 
not quite a third of the proportion which occurs in Norfolk. 
If we put aside from the calculation, the 15^ cases occurring in the Norfolk 
district, (comprehending Norfolk and Suffolk) with its population, we shall 
then have 1 calculous case for every 118,000 inhabitants, independently of that 
* Middlesex, Essex, Surrey, and Herts, may be regarded as hitherto principally dependent on the 
metropolis for Hospital accommodation; Kent, Sussex, Bucks, and Berks, as only partially so, per- 
haps to half their demand. 
