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ers are the breeders and intensifiers of the worst types of physical disease." Akt. Y. — Preputial Calculi. By J. G. Keek, M. D., Can- Order Cefaclor ton, China. Cefaclor Generic The cases of preputial calculi in the accompanying table are specimens of a complaint comparatively rare in Western countries. A paper, in a previous number of this Journal, will have shown the comparative frequency of urinary calculus in Southern China. Many cases of urethral calculus have been met with, and some specimens are in my possession, in which the diameters are one and one-fourth by one-half inch. Coexistent with these, as to latitude and climate, is the form of calculus now under consideration. Phymosis is not an uncommon deformity among the Chinese, and it is, of course, only in cases where this abnor- mal condition existed that preputial calculi could form. The cases included in the table were operated on in the Medical Missionary ^Society's Hospital in Canton, and I need but refer to tlie simplicity and entire freedom from danger of the operation, required for the relief of these cases, to show how utterly destitute of surgical skill the physicians of the oldest nation on the earth are, and how much Cefaclor Cd need there is of giving them the knowledge and appliances of western science and art. A reference to the table will show that in every case ex- cept one Purchase Cefaclor Online the calculi were multiple. In two cases the number exceeded one hundred ; in one there were forty, and in three others there were between twenty and thirty. In one or two cases the calculi were uniform in size and shape, but, in Buy Cheap Cefaclor most 284 PREPUTIAL CALCULI. of those where they were numerous, there were Cefaclor Antibiotics a few large and many small ones. Some had smooth, even surfaces, while others were angular, with facets. The most remarkable of the cases was 'No. 7, operated on in 1862. The patient was thirty-eight years old. The pre- puce was much thickened and enlarged, and the presence of calculi was easily discovered by a probe. A crucial incision was made in order to remove the Cefaclor Tablets stones, and the superfluous thickened skin was removed by circumcision. The calculi were two in number, and the weight one ounce and a quarter. The diameters of one were one and five-eighth by one and one- eighth inch. It had two concave facets, on opposite sides. Cefaclor Generation One facet which received the second stone was smooth and pol- ished. The concave Cefaclor Price facet on the other Purchase Cefaclor side was precisely like the first, except that it was slightly roughened Cefaclor Ceclor by recent de- posit. The second stone was one Cefaclor Monohydrate and a half inch in diameter, and was Order Cefaclor Online almost a perfect double convex lens in shape. One of its sides, where it rested on the other stone, was worn quite smooth, and it had evidently been shifted from one side of the first stone to the other, thus maintaining the completeness of the two concave facets. The calculi from case ISTo. 2 are in the possession of Prof. S. D. Gross, of Jefferson Medical Cefaclor 500mg Col- lege, Philadelphia. I will add Cefaclor 250mg an account of two more cases, not included in the table, because neither of them is strictly either preputial, urethral, or urinary calculus : Yip Akwong, aged twenty-one, was admitted into the Medi- cal Missionary Society's Hospital, July 27, 1867 (then in charge of F. Wong, M. D.), with an accumulation of calculi, in a sac half the size of a Cefaclor Antibiotic walnut, on the under side of the penis, about its middle, and communicating by a small opening with the urethra. It had existed since his childhood, but had given rise to no difficulty in passing water until recently. The sac was laid open by a free incision, and a large number of calculi removed. They w^ere of various sizes, whitish, smooth, and shining. Four of them were about the size of pigeons'-eggs, with irregular surfaces and angles. Six were smaller, oval in shape, Cefaclor Mg and angular. There were two hundred and eighty- one small pieces, varying in size from that of a pea to a millet seed. Total number, tv/o hundred and ninety-one. PREPUTIAL CALCULI. 285 The other case is, strictly speaking, one of lithotomy, but the stone was in an unusual situation : A patient, aged fifty years, from Buy Cefaclor Online Hoi-ping District, was admitted with strictm-e of long standing and urinary fistulas, which he persistently asserted had existed only about one year, but the appearance of the parts indicated a much longer duration. On probing the Cefaclor Cost fistulas, a stone was discovered, located on the right side of the contracted scrotum, near the groin. The fistula was enlarged toward the perinaeum, and the stone extracted. It weighed two and a half drachms, and its diameters measured one and a half by three-quarters of an inch. Its appearance indicated that it was composed of uric acid.

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