A monograph of 248 cases of lateral lithotomy operations [electronic resource] : performed in the north-western provinces during a period of twelve years
Ram Narain Dass, rai behadur
f^-a 9 -3 •a- Po P^ 5 3-g 1 H (Dp H <j -M *7 p p P.Hi-^ 'Sp'g ° a " do" V, Id P P Sp >P a "3 H -J -g l-l PP ° i 6 S ° o g « .3 § « CO o 00 I— I <-t CO oo cc»o vo t-* I— I T-H (N <M fa ' fa ^ CO c3 :: - <M us a a 1-1 O IM " »0 Q lO ^ OO " OO >-* i-H CO fa <M US (N CO I— < *— < •— t I <N CO r-l .•3 " to el a PI ^1 Ph CO t3 o CO o o o . i-H CO U) .g -a a Ph 60 .g as -<x us GS Oi bo a o 3l -si o 1 S C3 -a J . CO us o o o <N CO <N -a us o (N -a o 3 s o a o- g g 53 t 2 - =^ o -t-" o ^ . g d s a o a il s a S P OOt^OO-^OOt^OOCDCOOO C0»0 COCOt-IUOOJ i—tco I— ( OOO-—*-— ^' — ' T— ' — I ^ — 'CM e<)'MCT«<N<M(M(M(MIMC-)(M(M<N 42 LITHOTOMY. The statement of the nature and composition of the sixty-two stones from No. 1 to No. 62 in the Register was based upon a mere inspection of their form and appearance without any chemical or microscopical examinations, instruments and chemical reagents for the necessary examination not existing in a charitable dispensary. Sixty-one stones, out of these sixty-two which were sent to the Government with the half-yearly reports of the Dispensary, mounted on boards, had been stored in the College Museum, and the remaining one. No. 37 in the Register, has been lost in its circuit, as stated in the history of the case. The fifteen stones from No. 115 to No. 130 of the Register, exclusive of No. 123, were not then sent to the Government, as they were extracted just before my taking leave of absence for seven months, and the time for the usual half-yearly report had not then expired; in the like manner, and for a similar reason, the fourteen stones from No. 207 to No. 220 of the Register which were extracted just before my transfer from Budoan to the Calcutta Medical College were not sent to the Government; the stone in case No. 71 of the Register was lost; thus altogether there were ninety-two stones which were not examined chemically and microscopically. The remaining 128 of the 220 stones recorded in the Register of the Budoan Government Dispensary have been carefully examined. These 128 stones, which were sent to the Government with the half-yearly Reports of the Dispensary, each enclosed in a small cloth bag, together with a paper containing details of the name, age, and caste of the patient, with the date and result of the operation, had been stored in the College Museum. The sixty-two stones which were stored in the College Museum mounted on board in the manner stated above, have been lost, the cause I believe being that the stones getting loose from the boards, their identification became impossible, and they were ultimately set aside as worthless. Dr. Edward Goodeve, then in charge of the College Museum, advised me that sending stones mounted on boards from so long a distance as the North-western Provinces, was not a good plan, as on arrival he found many of them detached from their mounting. Acting on this advice, I subsequently sent them as above mentioned, each enclosed in a small cloth bag, in which condition they were stored in the College Museum. The Institution is such for sobvrb^ Air The Smithsonian Institution, located in the city of London, has been in operation for some time, and has been in operation for some time. I had no objection to their requisition, knowing that it would increase the reputation of the dispensary, and would induce the people to resort to it for aid in their medical and surgical diseases, for want of which aid hundreds were known annually to die. For the purpose of examination, each calculus has been neatly sawn through the center in the direction of its long flat axis. Of all the plans hitherto recommended for sawing calculus without breaking them, the following is I think the best. The calculus, protected on either side with soft rag or leather, is placed in the hollow A A at the end of an instrument, such as shown in the diagram, the two pieces of wood B B are kept together by two screws C C C, and are steadied by placing a third piece of wood, D, as a wedge between them: the upper screw is sufficiently tightened to hold the stone steady, and to make it immoveable during the working of the saw, and the third piece of wood also prevents too much pressure being accidentally applied to the stone by the tightening of the upper screw, and thus prevents crushing it. A bone saw, as shown in the diagram, was the instrument used for sawing. During the process of sawing water was constantly dropped into the cut part, to make it soft, and to keep the teeth of the saw clean by washing off the sawdust from them. When almost the whole of the calculus had been sawn through, it was taken out by loosening the upper screw, and The remaining part very gently sawn through whilst the stone was held with the left hand. The nucleus and the laminae, layers, or rings, which surround the nucleus and constitute the calculus, being thus clearly brought into view, have been carefully examined and analyzed. In the examination, the microscope has been invariably used in the following manner. I obtained by scraping with the point of a penknife samples of the nucleus and of each of the layers separately; these samples I placed on a piece of glass, moistening them with a little distilled water, and covering them with a piece of thin glass in the usual way. In this manner, uric acid and urate of ammonia have in every case been readily recognized, but oxalates and phosphates have not been so easily identified; and therefore for their detection, I have further chemically examined each specimen, and confirmed the results by a microscopic examination of the products. Not one of the calculi examined has been found to be simple in character; every one has been found to be composed of two or three substances, these have generally been of organic character, such as uric acid and urate of ammonia: and these organic substances almost invariably formed the basis of every nucleus. Inorganic substances, such as phosphates and oxalates, etc. Evered into the composition of the outer layer; but rarely, — viz., in few cases — did they enter into the composition of the nucleus, being there combined with uric acid and urate of ammonia. I have arranged and classified the calculi according to the composition of their nucleus as follows. 1st. Uric acid, called also lithic acid, is an organic product of the metamorphosis of the tissues, serving the same office as lU'ea, i.e., constituting a vehicle for the removal of an excess of nitrogen from the system. It is found in the excrementitious products of animals, but does not enter into the composition of any of the animal tissues, nor is it a component of the blood; it is found in the urine of many animals, and is a natural constituent of the urine of man and of the carnivorous animals. In certain diseases it is generated in considerable quantities, and is precipitated from the urine either in the form of small granular or crystalline particles, constituting the disease called gravel, or in form of solid masses, constituting what is called stony or calculus disease. The uric acid calculus may be divided into two varieties: one laminated, its texture compact and solid, and the surface smooth though granular or tuberculated, as in figure No. 11; the second variety. In imperfectly laminated, so as to give it a more dense and homogeneous appearance, and the surface rough, with its internal structure porous and of an earthy appearance, as in figure No. 34. There are few calculi which present these characters in a perfectly distinct and separate manner; the two forms are usually either mixed together or pass into one another by insensible gradations. A considerable difference in the degree of compactness and structural appearance of calculi is the result. LITHOTOMY. Most commonly, however, the porous or granular variety forms the nucleus of the calculus. There is another variety worthy of mention, the pea-shaped or pisiform uric acid calculus. This variety is characterized by its small size, which seldom exceeds that of a large pea or hempseed, and by the calculi being numerous instead of solitary: the internal structure of such calculi is invariably laminated, and they are often flattened on their surface, the flattening being caused by attrition against neighbouring calculi, as in figure No. 42. Besides the above physical characters, the chemical properties of a uric acid calculus are as follows. Uric acid possesses distinct acid properties, and in combination with alkaline bases forms a class of salts called urates or lithates; it is sparingly soluble in boiling water, and the solution on cooling deposits rhombic prisms of uric acid. It readily dissolves by boiling in caustic potash solution, and on adding to the solution a few drops of muriatic acid, the uric acid is precipitated, presenting at first a gelatinous appearance, and then assuming a crystalline form. If a small fragment be Heated on a watch-glass or on a piece of talc with a few drops of strong nitric acid, it effervesces, and on continuing the heat to dryness it acquires a beautiful purple colour from the formation of a substance called purpuric acid; and this colour is heightened by addition of liquid ammonia. Uric acid in a calculus is never found pure, but is always mixed with the colouring matter of the urine, and therefore in its crude state under the microscope the rhombic crystals are always coloured; moreover, it contains a certain proportion of animal matter, and hence when a small fragment is heated on platinum foil, or on a piece of talc, it immediately blackens, emitting a disagreeable smell resembling that of burnt feathers. On continuing the heat, the charred residue is consumed, and there remains a white ash, which is alkaline to test papers. Besides the coloring and animal matters, the following substances are usually present in varying proportions, urate of ammonia, urate of lime, oxalate of lime, phosphate of lime, &c. URINARY CALCULI OF WHICH THE NUCLEUS CONSISTS OF URINARY ACID. 1st. The micleus is of dark colour, and is composed of uric acid with traces of urate of ammonia, and the surrounding flame are Of light yellow colour, and are composed of uric acid with slight traces of urate of ammonia. It is a small oval calculus of light yellow and whitish colour externally, and also lightly tuberculated on its external surface, weighing 54. Extracted successfully from Darumdass, a Hindoo of fifty years old, on the 20th June, 1849, at the Budoan Government Dispensary. The nucleus is composed of uric acid with slight traces of urate of ammonia and oxalate of Lime, and the surrounding layer is uniform and not laminated, and is composed of oxalate of lime in abundance, with slight traces of urate of ammonia. It is largely tuberculated externally, and is a hard compact calculus, weighing 5. Extracted successfully from a Hindu lad named Punchum, of twelve years old, on the 24th July, 1849, at the Budoan Government Dispensary. The nucleus is composed of uric acid and urate of ammonia in equal proportions, and is porous, and the surrounding laminae are compact, and are principally composed of uric acid with traces of urate of ammonia. It is a roundish flat calculus of brown colour, and lightly granular on its external surface, weighing £1. Extracted successfully from Toolahram, a Hindu of thirty-five years old, on the 24th July, 1849, at the Budoan Government Dispensary. The nucleus is of dark colour, and is mostly composed of uric acid with traces of urate of ammonia, and the surrounding laminae are well defined but loosely connected with each other; therefore, on sawing the stone they separated themselves, and are found to be similarly composed as the nucleus. There were two calculi, one of large size and the other. Of the size of a seed of bean; the former has polished surface, and the other is rough, weighing together $3. Extracted successfully from Mohaboolah, a Muslim of sixty years old, on the 21st August, 1849, at the Budoan Government Dispensary. The nucleus is excentric, and is equally composed of uric acid and urate of ammonia, and the surrounding part is uniform and not laminated, and is porous, entirely composed of urate of ammonia. It is a small oval flat calculus, of light yellow color externally, and minutely tuberculated on its surface, weighing 54. Extracted successfully from a Hindoo of thirty-five years old, named Sobahram, on the 21st August, 1849, at the Budoan Government Dispensary. 6th. The nucleus is of dark colour, and is composed of uric acid with traces of urate of ammonia, and the surrounding layers are well marked and are also of dark colour, and are composed of uric acid and urate of ammonia almost in equal proportions, with traces of phosphate of lime. It is an oval calculus of light brown colour externally, weighing 53. Extracted successfully from a Mussulman of thirty years old, named Mahamud, on the 18th September, 1849, at the Budoan Government Dispensary. 7th. The nucleus is porous and not well defined, and is composed of uric acid with traces of urate of ammonia, and the outer layer is equally composed of uric acid and urate of ammonia. It is a small flat oval calculus, polished on its external surface, weighing 5. Extracted successfully from a Mussulman named Emmambodun, fifty years old, on the 18th September, 1849, at the Budoan Government Dispensary. LITHOTOMY, 11th LITHOTOMY, 11th LITHOTOMY, 11th LITHOTOMY, 12th LITHOTOMY, 13th LITHOTOMY, 14th LITHOTOMY, 15th LITHOTOMY, 16th LITHOTOMY, 17th LITHOTOMY, 18th LITHOTOMY, 19th LITHOTOMY, 20th LITHOTOMY, 21st LITHOTOMY, 22nd LITHOTOMY, 23rd LITHOTOMY, 24th LITHOTOMY, 24th LITHOTOMY, 25th LITHOTOMY, 26th LITHOTOMY, 27th LITHOTOMY, 27th LITHOTOMY, 28th LITHOTOMY, 29th LITHOTOMY, 30th LITHOTOMY, 31st LITHOTOMY, 31st LITHOTOMY, 32nd LITHOTOMY, 32nd LITHOTOMY, 33rd LITHOTOMY, 34th LITHOTOMY, 34th LITHOTOMY, 35th LITHOTOMY, 36th LITHOTOMY, 37th LITHOTOMY, 37th LITHOTOMY, 38th LITHOTOMY, 39th LITHOTOMY, 40th LITHOT The nucleus is composed of uric acid with traces of tirate of ammonia, and the surrounding layers are well marked, and are also similarly composed; the last layer, which is of a somewhat darker colour, is also composed mainly of uric acid, with slight traces of urate of ammonia. It is a compact oval calculus of large size, of dark yellow colour, polished on its external surface though granular or tuberculated, weighing 5½. Extracted successfully from a Hindoo named Bhowanee, of twenty years old, on the 6th November, 1849, at the Budaon Government Dispensary. 12th. The nucleus is composed of uric acid with slight traces of urate of ammonia; the first surrounding layers are coloured, and are composed of urate of ammonia, with traces of urate of ammonia, and the last surrounding layer is white, and is composed mainly of urate of ammonia. It is a roundish calculus of chalky colour, polished on its surface, weighing 58. Extracted successfully from a Hindoo lad named Nundram, of six years old, on the 27th November, 1849, at the Budaon Government Dispensary. 13th. The nucleus is composed almost equally of uric acid and urate of ammonia, and the surrounding rings are well marked, and are mostly composed of urate of ammonia, with traces of urate of ammonia, with traces of urate of ammonia. It is a middle-sized oval calculus of light yellow colour externally, weighing 54. Extracted successfully from a Hindoo lad of eight years of age, named Mohun, on the 26th December, 1849, at the  0..1cutt« CALCULI— NUCLEUS OF URIC ACID. 14th. The nucleus is excentric, and is composed of uric acid and urate of ammonia in equal proportions, and the next surrounding rings are composed of uric acid with slight traces of urate of ammonia; the last ring is whitish and porous, and is composed of uric acid with slight traces of urate of ammonia also. It is an oval flat calculus, tapering towards one end, where it is thicker than at the other, weighing 56. Extracted successfully from a Hindoo named Khomanee, of thirty-five years old, on the 30th December, 1849, at the Budaon Government Dispensary. 15th. The nucleus and the surrounding laminae are not distinct; the internal surface is porous throughout; they are composed of uric acid and urate of ammonia. They were two calculi, weighing 5s, and were broken during the extraction. Extracted successfully from a Hindoo boy of eight years of age, named Heera Sing, on the 15th January, 1850, at the Budaon Government Dispensary. 16th. The nucleus is composed of uric acid and urate of ammonia almost in equal proportions, and the surrounding layers are composed of urate of ammonia with traces of urate of ammonia with traces of urate of ammonia, and is exceedingly porous. It is an hour-glass shaped calculus, of white color externally, weighing 5s. Extracted successfully from a Hindoo lad of ten years of age, named Dillsook, on the 5th February, 1850, at the Budaon Government Dispensary. 17th. The nucleus is of dark colour in two places, and is composed of uric acid with traces of urate of ammonia; the surrounding laminae are just the contrary, containing mostly uric acid with traces of uric acid. It is a compact hard calculus of dark brown colour, weighing 5-- Extracted successfully from a Hindoo lad named Sarupsook, of five years old, on the 9th March, 1850, at the Budaon Government Dispensary. 18th. The nucleus is composed of equal proportions of uric acid and urate of ammonia; the surrounding rings contain uric acid principally with slight traces of urate of ammonia; the external surface is white; and is also similarly composed, the small calculus extracted with it is mainly composed of uric acid with traces of urate of ammonia. It is a calculus of triangular shape, of chaise colour externally; and the small one is of the same shape also, weighing 5 grs. 20. Extracted successfully from a Hindoo named Kharaj, of thirty-five years old, on the 9th March, 1850, at the Budaon Government Dispensary. 19th. The nucleus is composed of uric acid and urate of ammonia almost in equal proportions; the surrounding layer is one and all, and is porous, and is entirely composed of urate of ammonia. It is a middle-sized roundish calculus, of light yellow colour externally, weighing 5½ and gr. 40. Extracted successfully from a Hindoo named Urjoon, of eight years old, on the 25th March, 1850, at the Budaon Government Dispensary. 20th. The nucleus is not well marked, the whole of the internal part is porous, and the stone throughout is composed of uric acid and urate of ammonia. It is an oval flat calculus of light yellow colour and granular on its surface. and the internal part is of the same colour, weighing 521. Extracted successfully from Lokeman, a Hindoo lad of ten years of age, on the 25th March, 1850, at the Budaon Government Dispensary. URINARY CALCULI CALCULI — NUCLEUS OF URIC ACID. 53 21st. The nucleus and the next sun-ounding layers are well marked, and the rest is uniformly porous; the nucleus and all are equally composed of uric acid and urate of ammonia. It is an oval calculus of light yellow externally, weighing 54. Extracted successfully from a Hindoo lad of eight years of age named Mohun, on the 25th March, 1850, at the Budaon Government Dispensary. 22nd. The nucleus and the next surrounding layers are well marked, and the rest is uniformly porous, and every part of the calculus is composed of uric acid with traces of urate of ammonia. It is a middle-sized calculus, soft in its texture, and therefore it broke during extraction, and is of light yellow color externally, weighing 52. Extracted from a Mussulman of sixty years old, named Eohamut, on the 20th April, 1850, at the Budaon Government Dispensary, but the patient died thirteen days after the operation. 23rd. The nucleus is of light dark color and porous, and is composed of uric acid and urate of ammonia, almost in equal proportions, and the last surrounding white layer is also similarly composed. It is a middle-sized calculus of light brown color externally, and slightly tuberculated on its surface, weighing 55. Extracted successfully from a Mussulman named Hateem, of forty years of age, on the 23rd April, 1850, at the Budaon Government Dispensary. 54 L Extracted successfully from a Mussulman named Hateem, of forty years of age, on the 23rd April, 1850, at the Budaon Government Dispensary. THOUGHTS. 24th. The nucleus is not defined, and the whole of the internal part is of light yellow colour, and is porous, and is composed of uric acid and urate of ammonia. It is a flat roundish calculus of light yellow colour externally, and granular on its surface, weighing 541. Extracted successfully from a Mussidman named Munsa, of forty years old, on the 10th May, 1850, at the Budaon Government Dispensary. 25th. The nucleus is not defined, and the internal structure is not laminated, and is uniformly porous and white in colour, and every part of it is composed of uric acid with traces of urate of ammonia and of oxalate of lime. It is a small calculus of light yellow colour, with white deposits on its surface, weighing 33. Extracted successfully from a Hindu lad named Choliah, of ten years of age, on the 10th May, 1850, at the Budaon Government Dispensary. URINARY CALCULI urinary gal, cult. 2fi. Sect. WUTTUCflUh Thaokov, SpiJt* C'? Calcutta. CALCULI — NUCLEUS OF URIC ACID. 55 26th. The nucleus is of light dark colour, and is principally composed of uric acid with traces of urate of ammonia; and the surrounding layers are composed of uric acid and urate of ammonia almost in equal proportions. It is a small oval calculus of whitish brown colour externally, and lightly granular on the surface, weighing 33. Extracted successfully from Khansing, a Hindu lad of eight years old, on the 14th June, 1850, at the Budaon Government Dispensary. 27th. The nucleus and the surrounding coloured laminae are composed of uric acid and urate of ammonia in almost equal proportions, and the next surrounding laminae is White, and is composed of urate of ammonia with traces of uric acid and phosphate of lime, and the part between the white and coloured laminse is porous. It is an oval calculus of light yellow colour, weighing 37. Extracted successfully from Hossaina, a Mussulman lad of ten years of age, on the 19th April, 1851, at the Budaon Government Dispensary. The nucleus is distinct and surrounded by porous layers, and they are composed of uric acid and urate of ammonia. It is a pyramidal-shaped small calculus, and minutely tuberculated on the surface, weighing 3½ grs. 5. Extracted successfully from a Hindoo lad named Paransook, of eight years old, on the 28th April, 1851, at the Budaon Government Dispensary. 29th. The nucleus is excentric, and is of white color, surrounded by a dark-coloured lamina, and the next surrounding part is porous, and has on its external side a compact hard lamina of light brown colour, and all of them are composed of uric acid with traces of urate of ammonia. It is a flat oval calculus of light brown colour, weighing 3½. Extracted successfully from a Hindoo boy of ten years old, named Kanayah, on the 2nd June, 1851, at the Budaon Government Dispensary. LITHOTOMY. 30th. The nucleus is mostly composed of uric acid with traces of urate of ammonia and oxalate of lime, and the surrounding rings are porous, and are composed of urate of ammonia with traces of uric acid. It is a roundish calculus of light brown colour, weighing 3½. Extracted successfully from Mohun, a Hindoo lad of five years old on the 2nd June, 1851, at the Budaon Government Dispensary. 31st. The nucleus It is composed of uric acid with traces of uric acid, and the surrounding laminae are equally composed of uric acid and urate of ammonia. It is a small calculus, of light yellow colour externally, and granular on the surface, weighing grs. 20. Extracted successfully from Munnee, a Hindoo of forty years old, on the 9th June, 1851, at the Budoan Government Dispensary. 32nd. The nucleus is of pyramidal shape, of dark colour, and is composed of uric acid and urate of ammonia; the surrounding white part is porous and not well laminated, and is composed of urate of ammonia and triple phosphate in almost equal proportions. It is a long oval-shaped calculus approaching somewhat to an hour-glass shape; it is of chaUcy colour externally, weighing 56 grs. 5. Extracted successfully, from a Hindu lad of eight years of age, named Gomanec, on the 11th June, 1851, at the Budoan Government Dispensary. URINARY CALCULI 33. CALCULI — NUCLEUS OF URIC ACID. 57 33rd. The nucleus is of dark colour, and is composed of uric acid and urate of ammonia almost in equal proportions; the surrounding yellowish and bluish layers are also similarly composed, and the last layer is white, and is also similarly composed. It is a pretty large oval-shaped calculus of yellow colour, mixed with white deposits here and there on its surface, weighing 32. Extracted from a Hindu named Nuthoo, of fifty years old, on the 21st June, 1851, at the Budoan Government Dispensary; but the patient died three days after the operation. 34th. The nucleus is not well defined; it is uniformly wide and porous, composed of uric acid and urate of ammonia in equal proportions; the surrounding layer. It is hard and compact, and is also composed of uric acid and urate of ammonia. It is a large calculus of oval shape, of dark white color externally, and of light yellowish color internally, weighing £6 5s. Extracted successfully from Papee, a Hindoo of thirty-five years old, on the 21st June, 1851, at the Budaon Government Dispensary. LITHOTOMY. 35th. The nucleus is composed of uric acid with traces of urate of ammonia, and the sun-ounding rings are also similarly composed. It is a small oval calculus of light brown color externally, weighing £52. Extracted successfully from a Mussulman lad of ten years of age named Mohandee, on the 1st July, 1851, at the Budaon Government Dispensary. 36th. The nucleus is porous and excentric, and is composed of uric acid with traces of urate of ammonia; the surrounding part is white but not laminated, and the part towards the base is also white; these white parts are composed of urate of ammonia with traces of uric acid and phosphate of lime. It is a pyriform-shaped calculus of light brown colour externally, and minutely graniilated on its surface, weighing 53 gr. 15. Extracted successfully from Kaul, a Hindoo of thirty years old, on the 21st July, 1851, at the Budaon Government Dispensary. 37th. The nucleus is white, composed of uric acid with traces of urate of ammonia, and the surrounding black parts are also similarly composed; on sawing, the laminae separated themselves. It is largely tuberculated on the surface, but the tubercles are polished, and are of light dark colour, weighing 33 56. Extracted successfully from Munglee, a Hindoo of thirty years old, on the 4th August, 1851. At the Budaon Government Dispensary. LURINARY CALCULI Extract SreJ Tincker, Spink, Calcutta.. West-tuh. URINARY CALCULI 38 CALCULI — NUCLEUS OF URIC ACID, 59 38 3Sth. The nucleus is distinct and hollow, and the surrounding layers are also well marked, composed of uric acid and urate of ammonia. It is a small oblong calculus minutely tuberculated on the surface, weighing 32. Extracted successfully from a Hindu boy of three years of age named Ivhoondun, on the 13th August, 1851, at the Budaon Government Dispensary. 39th. The nucleus is composed of uric acid with traces of urate of ammonia, and the surrounding coloured layers are variously composed of uric acid and urate of ammonia, and the last white layer is composed of phosphate of lime, with traces of urate of ammonia. It is a large oval calculus of chalky colour externally, weighing 32.57. Extracted successfully from Cassum, a Mussulman lad of fifteen years old, on the 13th August, 1851, at the Budaon Government Dispensary. 40th. The nucleus and the surrounding layers are of light yellow colour, composed of uric acid and urate of ammonia, and the white layer on one side is entirely composed of urate of ammonia. It is a middle-sized calculus, little curved on one side, and little pointed on one end, of chalky colour, weighing 54. Extracted successfully from Munglee, a Hindoo lad of ten years of age on the 20th August, 1851, at the Budaon Government Dispensary. 40th. The nucleus is composed of uric acid and urate of ammonia almost in equal proportions, and is porous; the surrounding layers are also porous, and are composed of uric acid and urate of ammonia. It is a large calculus of somewhat triangular shape, of dark brown colour, with White deposits on its surface, which is granular though polished, weighing 32.56. Extracted from Mohave, a Hindoo of fifty years old, on the 20th August, 1851, at the Budaon Government Dispensary, but the patient died eight days after the operation. The nucleus and the surrounding laminae are well marked, and they are composed of uric acid and traces of urate of ammonia. Calculi are four in number, and besides twenty-three small ones from pea shape to the size of small grains, they are polished on their surfaces, weighing in all 57. Extracted successfully from Sumbhoo, a Hindoo of fifty years old, on the 25th August, 1851, at the Budaon Government Dispensary. URINARY CALCULI. Small, Calculi RaC Ream. SarainDaiit Bahxi Jam- uniformly porous, and is composed of uric acid with traces of uric acid, and the next and last dark line is also composed of uric acid and urate of ammonia. It is a middle-sized calculus of oval shape, of chalky colour externally, and granular on the surface, weighing 5 grs. 40. Extracted successfully from Punchum, a Hindoo lad of twelve years of age, on the 10th September, 1851, at the Budaon Government Dispensary. 43rd. The nucleus is mostly composed of uric acid, containing traces of urate of ammonia; and the next surrounding layer is composed of uric acid and urate of ammonia almost in equal proportions, and the part exterior to it is porous and is similarly composed. It is a large flat oval calculus, of light dark colour externally, and flatly tuberculated on its circumference only, weighing 2. Extracted successfully from Lahoreree, a Hindoo of forty years old, on the 1st September, 1851, at the Budaon Government Dispensary. LITHOTOMY. 46th. The nucleus is composed of uric acid and urate of ammonia almost in equal proportions, and the surrounding rings are of dark colour, and are also similarly composed. It is a roundish calculus of chalky colour externally, and largely tuberculated on the surface, weighing 56. Extracted successfully from Buxsee, a Mussulman lad of fifteen years of age, on the 12th September, 1851, at the Budaon Government Dispensary. 47th. The nucleus is mostly composed of uric acid with slight traces of urate of ammonia, and the surrounding rings are well marked, and are of light yellow color, composed of uric acid and urate of ammonia almost in equal proportions, and the outer layer is of slate colour, and is wholly composed of urate of ammonia. It is an oval calculus of light yellow colour externally, weighing 53 grs. 40 Extracted successfully from a Hindu boy named Hemraj, of seven years of age, on the 26th September, 1851, at the Budaon Government Dispensary. The nucleus is well marked, and composed of uric acid with traces of urate of ammonia, and the surrounding laminae are distinctly marked, and are also similarly composed of uric acid and urate of ammonia, and the external surface is composed of uric acid with traces of phosphate of lime. It is a small calculus, minutely granulated on the surface, weighing 52. Extracted successfully from Nooree, a Hindu lad of five years of age, on the 13th October, 1851, at the Budaon Government Dispensary. URINARY CALCULI Sect. Ext. 48. Theckner, Spink & Co., Calcutta. URINARY CALCULI 49 CALCULI — NUCLEUS OF URIC ACID. The nucleus is equally composed of uric acid and urate of ammonia; the surrounding part is not laminated, but porous, and exceedingly friable, and is composed of urate of ammonia, with traces of uric acid. It is a small calculus of chalky colour externally, weighing 56. Extracted successfully from a Hindoo, named Eucka, of six years old, on the 11th November, 1851, at the Budaon Government Dispensary. The nucleus is composed of uric acid and urate of ammonia, and the surrounding layers are composed of uric acid mostly, with traces of urate of ammonia. It is a small oval calculus of light yellow colour externally, weighing 52. Extracted successfully from Nawah, a Hindoo boy of eight years of age, on the 11th November, 1851, at the Budaon Government Dispensary. The nucleus is composed of uric acid and urate of ammonia almost in equal proportions, and the surrounding laminae are wholly composed of uric acid. The oxide of ammonia is a small calculus of yellowish white color externally, and lightly granular on its surface, weighing 52. Extracted successfully from Bullah, a Hindoo boy of eight years of age, on the 16th November, 1851, at the Budaon Government Dispensary. The nucleus and the laminae are composed of uric acid and urate of ammonia almost in equal proportions. It is a small oval calcukis and laminated, and the laminae are loosely connected with each other, and therefore separated by sawing, weighing 52. Extracted successfully from Joka, a Hindoo boy of ten years old, on the 16th November, 1851, at the Budaon Government Dispensary. LITHOTOMY. The nucleus is almost entirely composed of uric acid with slight traces of urate of ammonia; the surrounding white layer is also similarly composed. It is a large oval-shaped calculus, of white colour externally, and irregularly tuberculated on the surface, weighing 3½ lbs. Extracted successfully from Woomada, a Hindoo lad of eight years of age, on the 21st December, 1851, at the Budaon Government Dispensary. 54th. The nucleus is distinct and surrounded by a porous layer; they are composed of uric acid with traces of urate of ammonia. It is a small oval calculus of light brown colour, polished on its surface though minutely tuberculated, weighing 5 lbs. Extracted successfully from Ticcaram, a Hindoo boy of five years of age, on the 4th January, 1852, at the Budaon Government Dispensary. 55th. The nucleus is composed of uric acid and urate of ammonia almost in equal proportions; the surrounding rings are not well defined, and are porous, and similarly composed as the nucleus. It is a small roundish calculus of white colour externally, and minutely tuberculated on the surface, weighing 6 lbs. Extracted successfully from a Hindu boy of six years of age, named Bhamsing, on the 23rd January, 1852, at the Budaon Government Dispensary. Extract. Sect. Hal, Ram TioiraLnDaas Saho^Aoor. Thacker, SpmkS-C Calcutta. URINARY CALCULI CALCULI — NUCLEUS OF URIC ACID. 65 56th. The nucleus is of dark colour, and is composed of uric acid, containing traces of urate of ammonia and oxalate of lime in various proportions, the surrounding part is of light brown color, and is porous, composed mostly of oxalate of lime, with traces of urate of ammonia and uric acid. It is an oval-shaped calcuius of light brown colour, weighing 54 grs. 45. Extracted successfully from a Hindu named Lucka, of thirty years old, on the 25th January, 1852, at the Budaon Government Dispensary. 57th. The nucleus is excentric, and is composed of uric acid and urate of ammonia with traces of oxalate of lime, and the surrounding layer is white, and is composed of urate of ammonia, variously mixed with oxalate of lime. It is a roundish calculus of white colour externally, weighing 36 grs. 30. Extracted successfully from a Hindoo named Moolchund, of twenty years of age, on the 6th February, 1852, at the Budaon Government Dispensary. 58th. The stone broke into pieces during the extraction; the nucleus and the broken pieces are composed of uric acid with traces of urate of ammonia, weighing grs. 40. It is a small oval calculus, of brownish white color externally. Extracted successfully from a Hindoo named Joahur, of forty years old, on the 5th February, 1852, at the Budaon Government Dispensary. 59th. The nucleus is of dark colour, and is wholly composed of uric acid with traces of urate of lime. Ammonia, and the next surrounding layers are also of dark colour, and are also similarly composed, and the third layer is of brown colour, and is also similarly composed, and the external surface is of chalky colour, and is also similarly composed. It is an oval flat calculus of dark and light brown colour internally, and of chalky colour externally, weighing 385. Extracted successfully from Chadah, a Hindoo of forty years of age, on the 20th February, 1852, at the Budaon Government Dispensary. 2nd. STATE of ammonia. Urate of ammonia is often found forming the nucleus of a calculus, either alone or in combination with uric acid; when it forms the entire calculus, the stone is always of small size, and of flattened oval shape, and it is generally met with in early life. When it begins to form there is always great constitutional disturbance, accompanied with symptoms of great local irritation. It is either smooth or lightly tuberculated or granular on its external surface, and the colour of such a calculus is brownish grey or clay-coloured, it is always brittle, and therefore generally crumbles into pieces during extraction. When sawn through the internal structure is found to consist of a series of well-defined concentric layers or laminae, which are sometimes so very thin and so closely arranged as to give them a dense or homogeneous appearance; sometimes they are porous and earthy-looking. Besides the above physical characters, a urate of ammonia calculus or nucleus possesses the following chemical properties: 1. When a fragment is placed on a platinum foil, or on a piece Of talc, and then heated over a spirit lamp, the ammonia escaping from the compact texture crepitates with great violence, and the fragment gradually disappears, leaving but a small quantity of ash. It is more soluble in boiling than in cold water, and therefore when a strong aqueous solution cools a precipitate is formed of white flocculi, which under the microscope appear to consist of minute rounded particles adhering to each other and forming irregular linear masses or little stellated tufts of crystals. When boiled in a solution of potash, and a glass rod dipped in strong muriatic acid held over it, a decomposition ensues, and ammonia escaping unites with the muriatic acid and forms abundant white fumes of muriate of ammonia. When this test for ammonia does not give satisfactory result, a little bit of the calculus may be dissolved in dilute muriatic acid; muriate of ammonia is then formed, which remains in solution, whilst uric acid is set free as a precipitate. To the clear filtered solution add chloride of platinum, and then a yellow precipitate of chloride of platinum and ammonia is formed. When a small piece of urate of arainonia is heated with strong nitric acid, it produces, like uric acid, the beautiful purple compound, the colour of which is heightened by the addition of ammonia. The nucleus is composed of urate of ammonia, and the surrounding laminae are composed of the same substance, and the external surface is composed of urate of ammonia with traces of phosphate of Lime. It is a small calculus of whitish yellow colour externally, somewhat of triangular shape, and there was a smaller one with it, weighing together 32. Extracted successfully from Seetah, a Hindoo lad of ten years of age, on the 20th June, 1849, at the Budaon Government Dispensary. 60th. The nucleus is composed of Hthate of ammonia, and the next surrounding lamina are composed of uric acid varioxisly mixed with oxalate of lime. It is a large oval calculus of dark brown colour, weighing 521. Extracted successfully from a Hindoo named Tojah, of fifty years old, on the 20th June, 1849, at the Budaon Government Dispensary. 68 62nd. The nucleus is not well defined, it is continuous and porous, and surrounded by a compact lamina; the whole of the internal part is composed of urate of ammonia. It is a large hour glass-shaped calculus of light yellow colour, with white deposits here and there on its surface, and it is lightly granular, weighing 5. Extracted successfully from Pemraj, a Hindoo of fifty years old, on the 20th June, 1849, at the Budaon Government Dispensary. 63rd. The nucleus is excentric, and is composed of urate of ammonia and uric acid in almost equal proportions; it contains besides traces of oxalate of lime, and the surrounding layers are well marked and are also similarly composed, and the external surface, though white, is also similarly composed. It is an oval-shaped calculus, of white color externally, weighing 5. Extracted successfully from a Mussulman named Alluna, of forty years old, on the 29th June, 1849, at the Budaon Government Dispensary. 64th The nucleus is wholly composed of urate of ammonia, and the surrounding layers are well marked and are also similarly composed. It is a small oval calcidus, of light yellow colour externally, with white deposits here and there on its surface, weighing 53. Extracted successfully from a Hindu boy named Khanjun, of four years of age, on the 5th August, 1849, at the Budaon Government Dispensary. URINARY CALCULI 62. 63. 64. W.Wat i C luh.. Thaelcer, Spink's C°, Calculus. URINARY CALCULI 66. 65th. The nucleus is of white color, and is variously composed of urate of ammonia, oxalate of lime, and uric acid, and the surrounding layers are also similarly composed. There are two calculi in number, one a middle-sized, and the second small; they are of light yellow color externally, with white deposits here and there on their surfaces, weighing 3. Extracted successfully from Jesook, a Hindoo of sixteen years of age, on the 5th August, 1849, at the Budaon Government Dispensary. The nucleus is wholly composed of urate of ammonia, and the surrounding white layers are composed of uric acid and urate of ammonia almost in equal proportions. It is a small calculus, of light yellow mixed with white color externally, and minutely tuberculated on the surface; it had with it a pea-shaped calculus, weighing 32 in all. Extracted successfully from Gocool, a Hindoo of six years of age, on the 21st August, 1849, at the Budaon Government Dispensary. The nucleus is of dark color and porous, and is wholly composed of urate of ammonia; the concentric rings are principally composed of urate of ammonia, variously mixed with oxalate of ammonia. lime; the external surface contains more of oxalate of lime. It is a middle-sized calculus, of light brown colour externally, but the rings are of different colours; some of them are yellow, and others are of dark colour, weighing 5.5 lbs. Extracted successfully from a Hindu named Mackunlall, of forty years old, on the 30th September, 1849, at the Budaon Government Dispensary. The nucleus is entirely composed of urate of ammonia, and the surrounding laminae are well marked, and are composed of urate of ammonia and uric acid in almost equal proportions; and the last layer is white, and is almost similarly composed as the surrounding layers, with slight traces of phosphate of lime. It is an oval flat calculus, of chalky colour, largely tuberculated on its surface; it has with it a small calculus, of chalky colour also, and it is composed as the external white lamina, weighing 33. Extracted successfully from Khurgh, a Hindoo lad of eight years of age, on the 27th November, 1849, at the Budaon Government Dispensary. 70th. The nucleus is wide and porous, and is equally composed of urate of ammonia and uric acid; the surrounding rings are well defined, hard and compact, and are composed of urate of ammonia and uric acid. It is a large oval calculus, little flattened, of light yellow colour, and also lightly tuberculated on the surface, weighing 39. Extracted from Mungee, a Hindoo of forty years old, on the 25th January, 1850, at the Budaon Government Dispensary, but the patient died forty-two days after the operation. 69th, The nucleus is composed of urate of ammonia, surrounded by layers of urate of ammonia various. ly mixed with oxalate of lime; the third white layer is wholly composed of oxalate of lime, with traces of urate of ammonia; and the fourth layer is of dark colour, and is wholly composed of urate of ammonia. It is an oval calculus of dark colour, weighing 52. Extracted from a Hindu named Hurryram, of forty years old, on the 15th January, 1850, at the Budaon Government Dispensary, but the patient died seven days after the operation. URINARY CALCULI 68. CALCULI — NUCLEUS OF URINARY AMMONIA. 71st. The nucleus is composed of urate of ammonia with slight traces of uric acid; the next surrounding layer is of a light yellow colour, and is composed of equal proportions of urate of ammonia and uric acid; the second surrounding layer is also similarly composed; the last layers are not well defined, but are similarly composed of urate of ammonia and uric acid; the tubercles on the surface are large ones, and they are also composed of almost equal proportions of urate of ammonia and uric acid. It is a roundish calculus, largely tuberculated on its external surface, and is of a dark brown colour externally, with white deposits on its surface, weighing 51.30. Extracted successfully from Juggee, a Hindoo of thirty-five years old, on the 9th February, 1850, at the Budaon Government Dispensary. 72nd. The nucleus is wholly composed of urate of ammonia; the surrounding laminae are also entirely composed of urate of ammonia; and the external laminae, which separated During the process of sawing, were also found to be composed of urate of ammonia with slight traces of uric acid. It is a large roundish calculus, of brown colour with polished surface, weighing 52. Extracted from a Hindu boy named Sobah, of ten years of age, on the 19th February, 1850, at the Budaon Government Dispensary, but the boy died three days after the operation. The nucleus is composed of urate of ammonia with slight traces of uric acid; the next coloured rings or layers are well marked, and are similarly composed, and the outer white part is porous and crystalline, and is composed of urate of ammonia and triple phosphate with phosphate of lime. 