360 HEALTH AND DISEASE 



physiology, and physics led to the improvement of surgical methods, sur- 

 gical means, and surgical handicraft, the treatment of stone passed well- 

 nigh altogether from the domain of the physician to the more practical 

 and radical dispensation of the surgeon. 



Internal Remedies. — The internal remedies which have been recom- 

 mended and employed in this branch of treatment have been selected 

 purely on the ground of their chemical properties and action on alkaline 

 carbonates out of the body. A vesical calculus, it has been argued, con- 

 sisting as it does chiefly of calcic carbonate, should be chemically resolved 

 by the repeated administration of mineral acids, experience in the labora- 

 tory having taught that the decomposition of the former is readily and 

 surely effected by contact with the latter; hence mineral acids were for a 

 long time, and still continue to be, administered for the purpose of 

 bringing about a solution of the stone. Practical experience, however, 

 has at no time done much to confirm this time-honoured dogma, and the 

 teachings of physiology encourage no sort of belief in its therapeutical 

 value. Even in those instances where the operation of lithotomy is for- 

 bidden by the circumstances of the case, we are not warranted by any 

 consideration in relying on so precarious, nay useless, a remedy as the 

 so-called stone solvents. 



Injection of Stone Solvents into the Bladder. — Acid solutions 



directly introduced into the bladder stand in a very different position 

 to the calculus from those which, having been swallowed and having 

 traversed the alimentary canal, now enter the blood and circulate the 

 system in a state of extreme dilution. In the former case the solvent 

 and the substance to be acted upon are brought immediately into con- 

 tact with each other without having been exposed to any possible source 

 of decomposition, and in this instance the two chemicals are placed under 

 conditions which invariably yield a definite known result. On the other 

 hand, we have no assurance whatever that the acid which enters the 

 mouth ever reaches the bladder in an uncombined state. On the con- 

 trary, the absence of any therapeutical response to the continuance of 

 the remedy, as well as a knowledge of the chemical reaction of the 

 secretions (salivary, biliary, pancreatic, &c.) with which it must be brought 

 into contact in its course towards the blood, all go to suggest its speedy 

 neutralization and consequent inertness as a stone solvent. Clear as may 

 be the chemical action of acids on calcic carbonate, and constant as is the 

 composition of equine vesical calculus, there are nevertheless serious 

 objections to the general employment of such remedies in the treatment 

 of stone. In the first place, the strength of the solution injected into 

 the bladder must at all times be so weak as to produce the feeblest solvent 



