Volume 50 · Issue 06 · 1936

At a previous Biennial Meeting of the Chinese Medical Association (Caduceus IV. I. pg. 41, 1925) the present writer and Dr. T. Y. Li strongly advocated the routine use of litholapaxy for vesicaI calculi. It is not the purpose of the present note to repeat that argument. The writer now takes it as generally accepted that suprapubic cystostomy should be reserved for certain complicated cases of vesical calculi referred to below, but that to employ such operation for the usual straight- forward case is to give the patient second-best treatment only.

It must be confessed that any attempt to deal with the geographical distribution of bladder stone in this country can be tentative only. We are still lacking sufficient knowledge to make any complete report on the subject. There are however cerLain outstanding facts about which there can be no doubt and fairly reliable inferences can also be drawn from the reports of hospitaIs throughout the country.

It will be convenient to begin by detailing a number of points of clinical interest derived from the records of the Lester Chinese Hospital, Shanghai, during the years 1932-5. The number of patients in this series is 45, aIthough the total admissions of such cases to the hospital during this period would be about 60. The following may be noted:

Among the many causes of urinary cakuli suggested, avitaminosis A as an important etiological factor in experimental animals as well as in some clinical cases has been proved beyond doubt by numerous workers (Osborn and Mendel, 1917, Fujimaki, 1927, McCarrison, 1927, van Leersum, 1928, Perlmann and Weber, T928, de Langen, igzg, Higgins, 1933, and others). Other unbaIanced dietary ccnditions contributing to the formation of urinary calculi have been reported from time to iime. Chworastansky found kidney stones in 88 per cent of 58 rachiUe patients. Uyeda observed kidney stones in dogs kept on boiled polished rice and distilled water, a diet deficient in many respects. Padua noted cases of calculi among beriberi patients. Kirschner and Clemm recorded that gall stones more commonly occurred among people taking a low fat diet. Joly (1934) in a recent review reported that throughout the middle ages stones appeared to have been quite common in Europe, and in the i6th to the i8th century became a veritable scourge. The incidence increased after every protracted war and diminished when peace was established. The writer considered that lack of proper food stuffs was the chief cause. He also called attention to the fact that urinary calcuIi are now rare in Europe or America and this he attributed to "the improvement in the general conditions under which the population lives."

In January 1935, Dr. Branson kindly began to analyse samples of vesical calculi at the request of Professor Digby. Dr. Khoo assisted in collecting the early records. In the latter half of 1933, Professor Digby suggested that the author should direct and carry on the investigation. After Dr. Branson went on leave, Dr. Jackson carried on th work of chemical analysis.

Extravasation of urine is not an uncommon urological emergency. The paucity of accounts in literature prompts us to place this report on record. The report is based on a clinical study of thirty cases of extravasation of urine seen on the UrologiCail Service of the Peiping Union Medical College Hospital during the years, 1922-1932. The mechanism of the development of this condition is considered and treatment is discussed.

Congenital solitary kidney may be defined as an anomalous condition in which one kidney is absent due to a disturbance of growth of the nephrogenic tissue in embryonic life and in which the existing kidney has developed from one renal bud.

This paper is written in response to the request of the Chairman of the Surgical Section of the third Chinese Medical Association Conference. An attempt is made in this article to present some of the unusual features of bladder stone as seen in Manchuria.

Im Krankenhaus der Rheinischen Missionsgesellschaft in Tungkun habe ich in 10 Jahren 171 Blasensteinoperationen gemacht. Unter diesen 171 Lithotomien waren 14 Operationen wegen Recidiv einem Patienten, bei dem ich einen mandelgrossen Stein entfernte, waren sogar schon 2 Operationen wegen Blasenstein vorausgegengen.

In old Chinese medicine urinary calculi Shih lin 石淋 are classed as one of the five "Lin" diseases of the bladder, Lao lin 劳淋, hsueh lin 血�? jo lin 热淋, ch'i lin 气淋, shih lin 石淋.

In several of the articles, submitted for the Symposium on "Stone in the Urinary Tract in China", which formed the subject for the Surgical morning session at the last Chinese Medical Association Conference in Canton, two points are emphasized, firstly the importance of local causes in the formation of calculi, and secondly the fact that general as well as local factors undoubtedly play a large part in the deposition of stone forming material.