Treatment of Calculous Disorders. 215 



qtiiry, I know nothing beyond what has elsewhere' been men- 

 tioned. 



The idea of dissolving a calculus of uric acid in the bladder 

 by the internal use of the caustic alkalis, appears too absurd to 

 merit serious refutation ; it is not possible that they should reach 

 the bladder in a caustic state, in which state only they dissolve 

 uric acid ; and if they could arrive there, the mischief done 

 to the urinary passages would doubtless be such as to render their 

 use dangerous and impracticable ; so far, therefore, from 

 diminishing the bulk of a stone in the bladder by the solvent 

 power of the alkalis, they will, if not administered and watched 

 over with all caution, tend to increase its size by facilitating the 

 deposition of the phosphates. At the same time it cannot be 

 denied that the alkalis are very efficacious in preventing 

 the increased secretion of uric acid ; and when •adminis- 

 tered with that view, they may tend to prevent the increase 

 of a calculus as far as uric acid is concerned, and in that way 

 add to the chance of its being voided. How the alkalis act, is 

 a question, the discussion of which would lead to an inquiry too 

 extensive for my present purpose ; but since magnesia, and car- 

 bonate of lime, which are difficultly soluble substances, are 

 possessed of an influence over the secretion of uric acid, similar 

 to that of the soluble alkalis, it would seem probable that this 

 operation is chiefly carried on in the stomach and intestines, 

 and that the circumstance of the alkalis and their carbonates 

 passing off readily by the kidneys has not so much to do with 

 their lithontriptic virtues, as has been often supposed. 



In respect to the phosphates, it seems possible, that by keeping 

 up an unnatural state of acidity in the urine, a crust of the cal- 

 culus might so far be softened as to crumble down, or admit of 

 being scratched by an instrument, but this is the utmost that 

 can be looked for, and the uric nucleus remains a complete bar 

 to any perfect removal. 



These considerations, independent of more urgent reasons, 

 show the futility of attempting the solution of a stone of the 

 bladder by the injection of acid and alkaline solutions. In 

 respect to the alkalis, if sufficiently strong to act upon the 



