Treatment of Calculous Disorders. 69 



till the stone is voided ; and that the formation of a stone in the 

 kidney is not necessarily attended by any leading symptoms, is 

 proved by the numerous cases in which they have been dis- 

 covered after death in those viscera, without any mischief hav- 

 ing been suspected during the life of the patient; of this a very 

 remarkable instance is related by Dr. Marcet, in a patient who 

 died of hydrothorax, and who never complained of any affection 

 of the urinary organs, but whose kidney was distended by a 

 large collection of calculi. 



But acute pain almost always attends the passage of a cal- 

 culus along the ureter, and when this is followed by the expul- 

 sion of small grains of red sand in the urine, the nature of the 

 disease is sufficiently distinguishable from mere inflammation. 

 There is, however, seldom much diagnostic difficulty, for the 

 cases are very rare in which a calculus has made its way from 

 the kidney to the bladder, without sufficient warning; and we 

 usually hear of a sense of weight in the region of one of the 

 kidneys, succeeded by an obtuse pain of the part; the urine is 

 described as high coloured, and depositing a reddish sediment, 

 then comes the acute pain of the passage along the ureter, 

 generally attended by numbness of the thigh on the same side, 

 and of very variable duration ; this is succeeded by a period of 

 ease, which lasts either till symptoms of stone in the bladder 

 come on, or till the calculus enters the urethra : at this period 

 every means should be resorted to, that tend to the expulsion of 

 the stone, for as will afterwards be shown, the longer it re- 

 mains in the bladder the less likelihood will there be of getting 

 rid of it. Large quantities of aqueous drinks, and other mild 

 diuretics, should be resorted to, and the greatest benefit is fre- 

 quently derived from purgative medicines, the best of which in 

 these cases is the sulphate of magnesia, dissolved in a large 

 quantity of warm water, or the same salt with infusion and 

 tincture of senna. 



While on this subject it is necessary to bear in mind, that a 

 small calculus may lodge in the membranous part of the 

 urethra, and gradually enlarge there in consequence of the de- 



