1288 



URINE. 



pure triple phosphate is still less; thus in 

 Bartholomew's Hospital the proportion is as 

 1 : 129 ; in Guy's, as 1 : 43 ; in the Bristol, 

 as 1 : 218 ; in Copenhagen, as 1 : 19^ . 

 The other museums contain no specimen. 

 The general relation of the triple phosphate 

 in all the collections, is as 1 : 126f. 



" On the other hand, the proportion of cal- 

 culi composed of the mixed phosphates is 

 very considerable ; thus, in Bartholomew's 

 Hospital, the proportion is as 1 : 12^ ; in 

 Guy's, as 1 : 3+ ; in the Norwich, as 

 1 : 19 ; in the Manchester, (including those 

 containing a little lithic acid,) as 1 : 8 ; in 

 the Bristol, as 1 : 12 + ; in Swabia, as 

 1 : lli+; in Copenhagen, as 1 : I9f. The 

 relative proportion of the mixed phosphates 

 in all the collections is as 1 : 12-f-. 



" Under the head of the phosphates are 

 included a few rare specimens of other cal- 

 culi, e. g. carbonate of lime and siliceous cal- 

 culi. Of these two varieties, there is only 

 one of each reported to exist in the Copen- 

 hagen collection ; and one containing silex in 

 the Norwich collection. 



" The general proportion of all the calculi 

 arranged under the heads of the phosphates, 

 in the different museums, is as 1 : 10. 



" 5. Of alternating calculi. Calculi com- 

 posed of different layers constitute by far the 

 most frequent results of urinary diseases ; of 

 the successive forms assumed by which, they 

 may be said to constitute the index. We 

 shall first consider the relative proportions of 

 the calculi composed of two, three, and four 

 deposits ; and afterwards of the whole con- 

 jointly. 



" The proportion of alternating calculi com- 

 posed of two deposits is, in Bartholomew's 

 Hospital, as 1 : 2 ; in Guy's, none are 

 reported, probably on account of the calculi 

 not having been divided ; in Norwich, the 

 proportion of alternating calculi composed of 

 two layers is stated to be as 1 : 2-f ; in 

 Manchester, as 1 : 2 ; in the Bristol, as 

 1 : 3 ; in Swabia, as 1 : I+ ; and in Co- 

 penhagen, as 1 : 2i. The proportion of 

 alternating calculi composed of two layers, in 

 the conjoint collections, is as 1 : 2f +. 



" The proportion of alternating calculi com- 

 posed of three deposits, is, in Bartholomew's 

 Hospital, as 1 : 6 ; in Guy's Hospital, none 

 is reported ; in the Norwich Hospital, the 

 proportion is as 1 : 6-f- ; in the Manchester, 

 as 1 : 26f ; in the Bristol and Swabia collec- 

 tions, none is reported ; in Copenhagen, the 

 proportion is stated to be as 1 : 4 . The 

 proportion in all the collections, is as 1 : 8f . 



" Alternating calculi composed of four de- 

 posits are only reported to exist in the Nor- 

 wich Hospital, and the proportion stated is as 

 1 : 26|+. In the different collections there 

 are twenty-four alternating calculi, the com- 

 position of which is not stated. The propor- 

 tion of all the varieties of alternating calculi 

 in the different collections, is somewhat more 

 than one-half j that is, as 1 : 2 . 



" 6. Of mixed or compound calculi. In one 

 sense of the term, all calculi may be said to be 

 mixed or compound, as there are perhaps none 

 absolutely pure, i. e. y formed of a single in- 

 gredient. But in the sense in which the term 

 is here applied, namely, as expressive of cal- 

 culi composed of different ingredients mixed 

 together in large or nearly equal proportions, 

 compound calculi may be said to be rare. The 

 most usual mixtures consist of the lithate of 

 ammonia and of lime; of the oxalate, car- 

 bonate, and phosphate of lime ; of the lithate 

 of ammonia, and the mixed phosphates, &c. ; 

 and such mixtures are usually confined to 

 small calculi or calculous nuclei. Calculi 

 composed of pure lithic acid, or of any other 

 pure ingredient, with the phosphates or other 

 compounds, do not appear to exist ; at least 

 I have met with no such mixtures. 



" Lastly, it remains to make a few remarks 

 on the order of calculous deposits ; an inquiry 

 that throws considerable light on the laws of 

 their formation and general pathology. 



" On reference to the table it will be found, 

 that in the different alternating calculi, the 

 ratio in which the oxalate of lime succeeds to 

 lithic acid, is as 1 : 15f + ; on* the contrary, 

 that the ratio in which lithic acid succeeds to 

 oxalic acid, is as 1 : 13^-. Hence the alter- 

 nation of the two ingredients may be con- 

 sidered as nearly equal. It will be found, 

 however, that the oxalate of lime succeeds to 

 the lithate of ammonia, &c., more frequently 

 than to lithic acid ; thus the ratio in which 

 the oxalate of lime succeeds to the lithate of 

 ammonia was 1 : 9f . On the contrary, the 

 ratio in which the lithate of ammonia succeeds 

 to the oxalate of lime, is only as 1 : 38 ; a 

 very striking distinction. The ratio in which 

 the phosphates succeed to lithic acid, is as 

 1 : 9 ; in which the phosphates succeed to 

 the lithate of ammonia, is as 1 : 12 ; and 

 in which the phosphates succeed to the oxa- 

 late of lime, is as 1 : 1%+. On the contrary, 

 three instances only occur in which the lithic 

 acid or lithate of ammonia succeeds to a 

 phosphate ; and the proportion in which the 

 oxalate of lime succeeds to the phosphates is 

 as 1 : 253 only. The general proportion in 

 which the phosphates succeed to the other 

 ingredients in all the collections, is as 

 1 : 4^5+. Hence the generality of the im- 

 portant law alluded to in various parts of this 

 volume, that in urinary calculi a decided depo- 

 sition of the mixed phosphates is not followed by 

 other depositions" 



The following table, constructed by Dr. 

 Prout, illustrating the frequency of calculous 

 affections at different ages, and in the different 

 sexes, is from a paper published by Mr. Smith 

 in the eleventh volume of the Med. Chirurg. 

 Transactions, and from " A Treatise on the 

 Formation, Constituents, and Extraction of 

 Urinary Calculi. By John Green Crosse, 

 Esq., Surgeon to the Norfolk and Norwich 

 Hospital. London, 1835." 



