110 Dr. Henry on Urinary Calculi. [Feb. 



calculi generated in districts very remote from each other — a 

 fact wliich proves that the causes rendering the stone endemic 

 in certain countries act, not as was once imagined in supplying 

 directly the material of which the concretions are composed, but 

 in inducing a constitutional tendency to the disease. 



It was the opinion of some of the older writers, that all calcu- 

 lous concretions (with the exception of such as are formed oh 

 extraneous substances accidentally introduced into the bladder) 

 do in fact originate in the kidneys, and descending through the 

 ureters, merely acquire an increase in the bladder by attracting 

 sohd matter from the urine. To this opinion, which Fernelius 

 especially has ably supported,* it has been objected that stone 

 in the bladder is in many instances not preceded by any pain in 

 the region of the kidneys, or by the symptoms that denote the 

 descent of a stone through the ureter.f It is perfectly conceiv- 

 able, however, that a small calculus may find its way from the 

 kidneys to the bladder without exciting pain in its passage. The 

 opinion of Fernelius, and of others who agree with him, I find 

 also to be confirmed by the appearance of almost all the calculi 

 which I have ever examined, after having been divided by the 

 saw ; for, except in very few instances, a central nucleus maybe 

 distinctly seen, sufficiently ^mall to have descended to the 

 bladder through one of the ureters, even when that passage has 

 not been dilated beyond its natural diameter. The stone, there- 

 fore, is to be considered, essentially and in its origin, as a 

 disease of the kidneys. Its increase in the bladder may be occa- 

 sioned either by exposure to urine containing an excess of the 

 same ingredient as that composing the nucleus, in which case it 

 will be of uniform composition throughout ; or if the substance 

 composing the nucleus should, either by a spontaneous change 

 in the action of the kidneys, or by the effect of medicines, be 

 secreted in less than natural proportion, the concretion will then, 

 like any other extraneous body lodged in the bladder, acquire a 

 covering of the earthy phosphates. 



Under this view of the subject, it becomes highly important 

 to ascertain of what ingredient the nuclei of urinary calculi are, 

 for the most part, constituted, since it is in the tendency of the 

 kidney to generate this ingredient that the primary cause of the 

 disease must consist. Of the 187 calculi which I have examined, 

 17 have been formed round nuclei composed chiefly of oxalate 

 of lime ; 3 round nuclei of cystic oxide ; 4 round nuclei of the 

 earthy phosphates ; 2 round extraneous substances ; and in 

 three, the place of the nucleus is supplied by a small cavity, 

 occasioned probably by the shrinking of some animal matter, 

 round which the ingredients of the fusible calculus had been 

 deposited. J The remainder, amounting to 158, have a central 



« Fernelii Opera, p. .SIT, folio. + Bcverwyk de Cahulo, p. 69. 



+ Kail has shown, by a direct experiment, that pus xuny form the nucleus of ao 

 urinary concretion. — (See Denjs de Calculo Ilenuu), &c. p. 14.) 



