214 CALCULUS. 



CALCULOUS CONCRETIONS 



are of far more frequent occurrence than is generally imagined, but they 

 are not confined to the kidneys ; there is scarcely a portion of the frame in 

 which they have not been found, particularly in the brain, the glandular 

 substance, and the coats of the intestines. 



I cannot say with Mr. Elaine that I have seen not less than 40 or 50 

 calculi in my museum ; but I have seen too many fearful examples of the 

 complaint. There has been usually great difficulty in the urinary evacua- 

 tion, and at length one of the calculi enters the urethra, and so blocks up 

 the flow of the urine that mortification ensues. 



M. Lautour relates a case of renal calculus in a dog. He had occa- 

 sionally voided his urine with some difficulty, and had walked slowly and 

 with evident pain. August 20, 1827, a sudden exacerbation came on, 

 and the dog was dreadfully agitated. He barked and rolled himself on 

 the ground almost every minute ; he made frequent attempts to void his 

 urine, which came from him drop by drop. When compelled to walk, his 

 hind and fore legs seemed to mingle together, and his loins were bent into 

 a perfect curve ; his flanks were drawn in ; he could scarcely be induced 

 to eat ; and he evidently suffered much in voiding his faeces. Mild and 

 demulcent liquids were his only food. Warm baths and injections were 

 applied almost unceasingly, and in eight days he seemed to have perfectly 

 gained his health. 



In March, in the following year, the symptoms returned with greater 

 intensity. His hind limbs were dragged after him ; he rapidly lost flesh, 

 and his hovvlings were fearful and continuous. The same mode of treat- 

 ment was adopted without any good effect, and, his cries continuing, he was 

 destroyed. 



The stomach and intestines were healthy. The bladder was enlarged 

 from the thickness and induration of its parietes ; the mucous membrane 

 of it was covered with ecchymoses ; the kidneys were three or four times 

 their natural size; and the pel vis contained a calculus weighing 126 grains, 

 composed of 58 grains of uric acid and 58 of ammonia, with 10 grains of 

 phosphate of lime. 



Of the nature and causes of urinary calculi in the bladder we know very 

 little. We only know that some solid body finds its way, or is formed, 

 there, gradually increases in size, and at length partially or entirely oc- 

 cupies the bladder. Boerhaave has given a singular and undeniable proof 

 of this. He introduced a small round pebble into the bladder of a dog. 

 The wound perfectly healed. A few months afterwards the animal was 

 killed, and there was found a calculus of considerable size, of which the 

 pebble was the nucleus. 



Occasionally the pressure of the bladder on the calculus which it contains 

 is exceedingly great, so much so, indeed, as to crush the calculus. A small 

 calculus may sometimes be forcibly extracted, or cut down upon and re- 

 moved ; but when the calculus is large, a catheter or bougie must be passed 

 up the penis as far as the curve in the urethra, and then somewhat firmly 

 held with the left hand, and pressing against the urethra. A scalpel should 

 be taken, and an incision made into the urethra. The catheter being now 

 withdrawn, and the finger or a pair of forceps introduced into the bladder, 

 the calculus maybe grasped and extracted. 



