RENAL CALCULI. 493 



depended upon. In the e?irly formation of the stone in 

 kidney, and for the most part during its increase, it would 

 appear that little or no inconvenience — certainly no expressed 

 pain — is occasioned by it. When it becomes weighty, how- 

 ever, and fills up the pelvic cavity, it must create considerable 

 impediment to the flow of urine, as well as prove a source of 

 more or less annoyance and irritation, which is likely to be 

 manifested from time to time by symptoms undistinguishable, 

 perhaps, from those of '^ gripes /^ though this irritation pro- 

 bably is in some degree lessened, perhaps altogether counter- 

 acted, by the hypertrophy of the cavity containing it keeping 

 pace with the incrementation of the stone ; and this is accom- 

 panied by dilatation of the infundibula as well, and by general 

 augmentation of the gland itself. These changes are often 

 attended by inflammation and suppuration. Purulent matter 

 pervades, and in time fills, all the canals and cavities; and 

 sooner or later the subsequent work of disorganization com- 

 mences, and absorption of the substance of the gland follows; 

 first of the medullarj'^, and afterwards of the cortical composi- 

 tion, in a greater or less degree, until the deformation ends 

 only with the destruction of life. Periodical colics, with ex- 

 pressions of extreme suflering, and these coming on after 

 exercise or exertion of any kind, and again ceasing as sud- 

 denly as they appeared, leaving behind them sedimentous 

 and gravelly urine, are what D^Arboval has off"ered as the 

 symptoms denoting this state of kidney. The condition of 

 the urine might certainly lead to a suspicion of stone, and 

 the absence of any in the bladder or urethra might induce 

 us to assume the presence of one in the kidney. 



Our Treatment must be directed to the mitigation of 

 irritation, and any consequent febrile disturbance. Blood- 

 letting and purging; fomentations, and mustard plasters to 

 the loins ; clysters ; and the subsequent exhibition of acids 

 — the acetous is one of the best — with a view of dissolving 

 or rendering unirritating the calculous matters. Purgatives 

 during the intervals of ease are also recommended, on the 

 ground of the commotion in the bowels produced by their 

 action being likely to cause a descent of the calculus. 



