SOS 



CALCULUS. 



CALCULUS. 



500 



quite white, and consist of carbonate and phosphate of lime, combinec 

 with much animal matter. 



Calcareous deposits are also found occasionally imbedded in th 

 muscles (where however they partake more than in other situations c 

 the fibrous nature of bone), on the surface of the spleen and pleura, i 

 the brain, and other organs, and in various morbid growths of a cai 

 cerous, scrofulous, or fungous nature ; as well as round foreign sub 

 stances of any description retained in the body, and subject to th 

 action of its fluids. * They do not admit of classification, but all con 

 sist of combinations of lime with carbonic or phosphoric acid, an 

 animal matter. 



Chalk-stones. Gouty and rheumatic persons are subject to the de 

 position of a matter thus denominated, and resembling half-driec 

 mortar, under the skin, about the joints chiefly of the fingers and toes 

 They have been met with in severe and long-continued rheumatism o 

 the head beneath the skin which covers the cartilage of the ear. Thej 

 frequently excite uleeration, and when, they protrude externally ma' 

 be removed ; but an operation is rarely resorted to. They are 

 to consist of urate of iotla. 



Intestinal Calculi. The bowels are sometimes obstructed by roundec 

 masses, formed by the agglutination of dry fibrous particles, such fo 

 instance as the fine down or beard of the oat, which is not entirely 

 removed by sifting the meal. These concretions usually form round a 

 small piece of bone, a plum-stone, or other such body. They are 

 smooth and compact in their structure, but of small specific gravity 

 the fibrous matter of which they consist occasionally alternates with 

 concentric larnimc of phosphate of lime, which usually forms a layer 

 upon then- surface. The circumstances which lead to their formatior 

 are obscure, but are possibly connected in some measure with consti 

 tutional predisposition, as they are found to recur habitually in th< 

 same person in spite of all precautions. The symptoms and most 

 appropriate remedies for this complaint will readily suggest them 

 selves; but its existence is in most cases rather suspected than 

 ascertained till the calculus passes, as the symptoms may arise from 

 other and very different causes of obstruction. 



i. Calculi thus denominated are frequently found in the 

 gall-bladder, or reservoir of the bile, which is attached to the liver 

 especially in persons who have reached the middle period of life, and 

 have been long addicted to luxurious habits, or whose general health 

 has been seriously impaired by mental distress or bodily ailment. 

 They are often numerous, and one instance is recorded in which nearly 

 three thousand were found at once. Generally, however, there are not 

 more than three or four, and they are often solitary. They consist oi 

 one or more of the constituents of bile, with the occasional addition of 

 phosphate of lime, and are white, or of shades intermediate between 

 this colour, brownish yellow, and dark green. The white consist 

 almost wholly of choleslerine (from x**J> bile, and ortpeis, solid), a 

 substance like spermaceti, first detected in the bile by Chevreul. The 

 intermediate shades are composed of this substance, with more or less 

 admixture of bile ; and the darker kind seem to consist entirely of bile 

 itself, inspissated. The last are rough and friable in their texture, 

 sometimes much resembling cinders; the lighter varieties, on the 

 contrary, are smooth ami unctuous to the touch, presenting surfaces 

 apparently flattened by mutual pressure. They are moreover distinctly 

 crystalline, and sometimes lamellated, as if deposited in successive 

 layers. 



Biliary calculi are not productive of much inconvenience as long as 

 they remain in the gall-bladder ; but when they are protruded through 

 the proper duct of that organ into the canal by which the bile passes 

 from the liver into the intestine called the duodenum, they occasion 

 great pain and disturbance of the health. The pain occurs in paroxysms, 

 and is seated in the pit of the stomach, or a little lower and to the 

 right, shooting to the back ; and it is generally attended with vomiting 

 and shivering, but not at first with a quickened pulse. If the bile be 

 wholly obstructed, the evacuations lose their colour, and become un- 

 f requcnt ; the skin is tinged with a deep yellow, or jaundiced, as it is 

 termed ; rapid emaciation succeeds, with fever, and extreme dejection 

 and weakness. The event is sometimes fatal, but in general the 

 stone passes at length into the duodenum, the flow of bile is re-esta- 

 blished, and the disturbance subsides. The best remedies are emetics, 

 aperient*, opium, the warm bath and fomentations, and occasionally 

 bleeding. 



..,,-,, i ',/,',,///. The 'urine is a very complex fluid, holding in solu- 

 tion at least twelve different ingredients in health, and more in disease. 

 Home belong to the class of acids, as the uric, phosphoric, and oxalic ; 

 others are alkaline or earthy, as ammonia, soda, lime, and magnesia. 

 In certain conditions of.the system these elements are no longer kept 

 in complete solution, but are precipitated or combined in a solid form, 

 constituting various kinds of crystalline or sedimentary deposits, often 

 arranged in successive layers ; thus inducing those well-known affec- 

 tions, yrarel and t<mt in the bladder. 



Ktnal Calcutta and (travel. Urinary concretions for the most part 

 originate in the pelri* or hollow part of the kidney, either as small 

 stones, or in the form of minute sand-like crystals. In this situation 

 they are called renal calculi (from mi, the kidney). They may 

 remain there' permanently, and even attain a considerable size, so as to 

 distend the cavity and cause absorption of the gland itself, without 

 more inconvenience than an occasional sense of weight and a dull 



aching in the loins. They may also produce inflammation and abscess 

 of the kidney, which sometimes ends in the discharge of the stone with 

 the other contents of the abscess through an ulcerated opening in the 

 back ; and sometimes in a lingering death. More commonly the de- 

 posite is carried with the urine, while yet of small size or in the form 

 of sand, into the ureter or duct of the kidney, along which it descends 

 more or less slowly into the bladder, with symptoms much resembling 

 those which attend the passing of a gall-stone. These are shivering, 

 sickness of the stomach, pain shooting in paroxysms from the back to 

 the groin, and down the thigh of the same side ; and, in males, retrac- 

 tion of the corresponding testicle. The circulation does not partake 

 in the disturbance unless the calculus be so large as to obstruct the 

 ureter, and thereby excite inflammation of the kidney. These symp- 

 toms constitute what is called a fitoftheyravcl, and generally termi- 

 nate in the expulsion of the offending matter with the urine, which is 

 not effected without much pain in the neck of the bladder and the 

 urethra ; the urine being voided in small quantities and with difficulty, 

 and occasionally mixed with blood. The remedies employed in gall- 

 stone afford relief in a fit of gravel. Copious draughts of some mild 

 warm fluid should also be taken, with small doses of alkaline or other 

 medicines, suited to the nature of the deposite. 



Vetical Calculi. It sometimes happens that a renal calculus, having 

 reached the bladder in the manner described, is detained there, and 

 becomes the nucleus of fresh concretions. Vesical calculus may also 

 be formed upon a foreign body, such as the broken end of a catheter, 

 or upon a small stone which has made its way inwards. Nuclei of 

 this last kind are formed originally in the ducts of the prostate gland, 

 which surrounds the male urethra just where it issues from the 

 bladder, and consist of phosphate of lime. 



In whatever way it may first arise, retical calculus or stone in the 

 bladder is one of the most dreadful maladies to which man is exposed. 

 Even in its nascent state, but most certainly when it becomes at all 

 large, the stone occasions excruciating pain. This is seated chiefly in 

 the neck of 'the bladder where the stone usually rests, and, by sym- 

 pathy, in the urethra near its external orifice : it is attributable, in a 

 great measure, to the strong spasmodic contractions of the bladder 

 upon the stone, and is most severe immediately after micturition. 

 Hence, fortunately, it is intermitting ; for when the bladder is full, 

 the weight of the stone is partly sustained by the fluid, and it does 

 not touch the sensitive internal membrane in so many points. In 

 some cases the pain is more endurable than in others from peculiarity 

 of constitution, or the comparative smoothness and lightness of the 

 stone ; but sooner or later the period of agony arrives ; the bladder 

 jecomes intolerant of the smallest amount of distension, BO that the 

 urine is voided, as it enters, drop by drop, mingled with blood and 

 mucus ; and at length the patient inevitably dies, worn out by unre- 

 mitted suffering. 



There are remedies which are capable of affording a certain amount 

 of relief for a time ; but the only means that offer even a chance of a 

 lappier termination than death itself, are the removal of the cause by 

 an operation. The stone must either be withdrawn through the 

 urethra by a properly constructed instrument, which often succeeds 

 when it is small in the male, and seldom fails in the female unless it 

 )e large ; or it must be drilled and crushed into fragments small 

 enough to be voided with the urine, according to a brilliant method of 

 jperating lately brought into notice [LITHOTUITY], or an incision must 

 >e made large enough to permit its extraction [LITHOTOMY] ; a method 

 >ractised by the ancients, and unfortunately by no means superseded 

 as some imagine) by lithotrity, which is out of the question in very 

 roung children, and often inapplicable in more advanced life. This 

 disease is curable by the various means that have been devised, or a 

 jombination of them, in perhaps five or six out of seven cases, even in 

 ts advanced stage; and the average number of failures in young 

 ;hildren does not amount to one in fourteen. It is always advisable 

 hat an operation should not be delayed when the existence of stone 

 s proved, which, it may be observed, can only be done by actually 

 triking it audibly with a metallic instrument called a sound ; for not 

 inly is the stone constantly increasing in size, but the parts concerned 

 may become incurably diseased in consequence of delay, or the general 

 lealth may sink beyond the power of restoration. The idea of dis- 

 olviug the calculus is a dream. 



It is a curious fact in the history of this disease, that it is exceed- 

 ngly common in some places and very rare in others. Thus at Norwich 

 nd Paisley together there are probably more cases in a year than in 

 he whole of London ; while at Hereford the disease is almost un- 

 nown. No researches into the cause of this difference have yet 

 fforded a satisfactory explanation of it. 



It would be tedious to enter at length into the chemical nature of 

 rinary calculi. In weight they vary from a few grains even to several 

 ounds, but seldom exceed a few ounces. They have been distin- 

 uished (chiefly by the labours of Dr. Wollaston) into the follow- 

 ng kinds, which are here arranged nearly in the order of their 

 requency : 



1. Uric acid. 



2. Oxalate of lime, called also the mulberry calculus, from its dark 

 olour and rough surface. 



3. Ammoniaco-magnesian phosphate; called also the triple-phos- 

 late. 



