Report on Calculous Affections, 175 



the relative proportions of the different professions. It is true 

 there are many more in the indigent classes ; but this is partly 

 owing to these classes being much the most numerous, and part- 

 ly because unhappily also, all the ills of life, and especially dis- 

 eases, weigh most heavily upon them. 



M. Civiale has arrived at nearly the same conclusions with 

 regard to the influence of climate. Stone has been observed 

 nearly equally in all countries. The contrary assertions, so of- 

 ten made, are the result of exaggeration and error. It is true 

 that many circumstances, either unobserved or inaccurate, have 

 contributed to propagate this error. If, from any circumstance, 

 general attention was more especially directed to a particular 

 disease, this is enough apparently to increase the number of in- 

 stances. Thus, for example, during the life of the eminent 

 lithotomist Row, it might be supposed that stone was a very 

 common complaint in Holland, from the many operations which 

 were then performed at Amsterdam. But after the death of 

 Row, the number speedily diminished to one-half, and the num- 

 ber is now reduced to one-third. 



Many other equally curious practical conclusions might be 

 drawn from these tables. The calculous matter which collects 

 under the influence of a catarrhus vesicae, or other chronic affec- 

 tion, is usually composed of phosphate of lime, or ammoniacal 

 magnesian phosphate. At the same time, it is not to be over- 

 looked that calculi, in their turn, equally give rise to the above 

 complaints. Relapses are very common, whatever method of 

 relief has been employed. This fact was well known before the 

 introduction of lithotritis. They occur most frequently in those 

 who are troubled with a chronic affection. M. Civiale affirms, 

 that all that class of diseases more speedily cease after lithotritis, 

 than after cutting ; and he adds, there is always more or less 

 danger in repeating the operation of cutting, whilst there is 

 scarcely any in that of pulverizing. 



It is, however, especially a comparison of the different modes 

 in which the calculi are treated and removed, that has engaged 

 the attention of M. Civiale ; and it is this principal part of his 

 work which merits the most attention. 



All the methods which have been successively employed against 

 this cruel malady may be arranged, with sufficient accuracy, 



