60 
DR. YELLOLY’S REMARKS ON THE 
diseases has been nearly as great, during the first sixteen years of life, as in 
the whole after period ; but if we take the cases afforded by Norwich and 
London, independently of their respective country districts, as many cases of 
calculus have occurred below 1 4, as above that age ; so that in those two in- 
stances, the proportion of children affected with this complaint, (judging from 
the hospital returns,) has been larger in a town, than in a country situation. 
With regard to the mortality from the operation of lithotomy, the number 
of deaths in the Norfolk and Norwich Hospital, has been 89, which is a mor- 
tality of 1 in 7-29 cases, from the institution of the charity. But it is credit- 
able to the state of modern surgery, and to the skill of the present surgeons of 
that Hospital, that in the operations performed by them (which amount to 
near one third of the whole number from the commencement), the proportion 
of deaths has been reduced to 1 in 8.42, which differs very little from the 
average of Cheselden, whose improved lateral operation they follow*. 
afford their full complement of men to the British navy, but have less tendency to calculous diseases, 
according to our present evidence, than England ; it will not be found, even if we take the smaller 
population of 1810, instead of that of 1820, that the proportion of those complaints, among large 
bodies of natives of the three kingdoms, between 14 and 50 years of age, acting together, will differ 
much from that stated by Mr. Hutchison. 
* Cheselden is generally considered as having lost only 1 patient in 10|, in his hospital lithotomy 
practice ; but the summary referred to, of 20 deaths in 213 cases, applied only to the success of his 
improved lateral operation. As far as existing documents afford evidence on the subject, (Anatomy, 
book iv. chap. 6 ; and Treatise on the High Operation, p. 17), that great surgeon, who was distin- 
guished for candour and ingenuousness, lost, previously, 8 cases out of 28, which raised the average 
mortality of his hospital practice to 1 case in 8.6. His great success was in children ; for the state- 
ment given by him, evinces his mortality to have been 1 in 5\, of even his most successful operations, 
in persons above 14. I may likewise remark, that it was foreign to Cheselden’s plan, to notice any 
operations, but those immediately connected with his historical view of lithotomy ; and he did not 
therefore record, in his publications, the number or result of any which occurred to him in St. 
Thomas’s Hospital, between the time of his appointment to that charity in 1718, and his first men- 
tioned high operation in 1722. — It is also important to bear in mind, in referring to Cheselden’s 
mortality, that some of the patients who were included among his successful cases, were carried off by 
small-pox, in the Hospital, before their complete recovery. He gives it as his opinion, indeed, that 
such deaths were not in greater proportion, than might be expected to have occurred from small -pox 
alone ; and the well-known uprightness of his character, entitles this opinion to every degree of credit. 
Hence, in strict correctness, they do not affect the accuracy of his general statement. In the Norfolk 
and Norwich Hospital, however, it is the invariable practice, for no case to be put down as a recovery 
from the stone operation, if the patient die in the hospital, of any disease which may even have come 
on during his convalescence. 
