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 interior, 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 
1 0 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 Trye 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. H 
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. 
