36 M E D I C I N E. 



?rlc*. sition of calculous matter from this fluid ; or by the dies. In one of these a calculus is formed of an acid 

 "* V"*' presence of a calculus in the bladder, as ascertained by 



the introduction of the sound. 



The exciting or predisposing cause of the disease is 



probably, in all cases, a derangement of the digestive 



organs, by which the fluids undergo some change in 



their nature, so that, in passing through the kidney, 



certain substances are secreted that concrete together 



into solid masses. These, according to their form, and 



the situation where they are deposited, produce various 



distressing symptoms, that are immediately to be at- 

 tributed to their mechanical bulk, either pressing upon 



the contiguous parts, or obstructing the discharge of muriatic acid, according to the result of the examina- 



the natural excretions. Very minute attention has been *'" Rneidpe thosp WP are tn rrivp nnnrutivps frpplv 



dies. 



nature, which it may therefore be supposed will re- 

 quire alkaline medicines for its prevention ; while in 

 others there is a tendency to the formation of a calcu- 

 lus in which an alkaline earth predominates, and which 

 may therefore be supposed to indicate the employment 

 of acids for its prevention. Upon this principle, we 

 have been directed, in the treatment of Lithiasis, first 

 to examine into the state of the urine, and into the na- 

 ture of the calculous deposition, or of any solid matter 

 which may have been discharged, and to administer 

 either the carbonates of the fixed alkalies, or diluted 



Practice 



paid of late years to the chemical analysis of urinary 

 calculi ; and, according to the most accurate experi- 

 ments, we may arrange them under the following 

 heads: 1st, The lithic calculus; 2d, The bone earth 

 calculus, consisting principally of phosphate of lime ; 

 3d, The ammoniaco-magnesian phosphate ; 4th, The 

 fusible calculus, consisting of a mixture of the two 

 former ; 5th, The mulberry calculus, composed of oxa- 

 late of lime ; (ith, The cystic, consisting of the peculiar 

 substance called cystic oxide. To these we may add 

 the alternating calculi, those that are formed of differ- 

 ent substances arranged in alternate layers ; and the 

 compound calculi, composed of different ingredients 

 mixed together without any regular order. 



Treatment. As urinary calculi are properly extraneous bodies, 

 and do not possess any vital properties, it has been al- 

 ways considered a most important point to discover 

 some chemical agent, by which they might be render- 

 ed soluble, and in this way discharged along with the 

 urine. Until very lately all the attempts that had been 

 made of this kind were entirely empirical, and, not- 

 withstanding various flattering accounts which, from 

 time to time, had been laid before the public, were al- 

 together abortive ; but since the greater accuracy of 

 modern chemistry, their nature has been thoroughly 

 investigated, and we are well acquainted with means 

 by which most of them may be readily dissolved out of 

 the body. It still, however, remains a doubtful point, 

 whether, while they are in the bladder or the urinary 

 passages, any re-agent taken into the stomach, can be 

 carried along the circulation so far unaltered, as to be 

 capable of acting upon the calculus through the inter- 

 vention of the urine ; and, upon the whole, we are dis- 

 posed to think that but little can be expected from this 

 mode of proceeding. But, although we may fail in this 

 object, there are still two methods of relieving the dis- 

 ease ; one, indeed, which is extremely painful, and af- 

 ter all merely palliative, viz. by cutting into the blad- 

 der, and removing the calculus ; the other, which, if it 



tion. Besides these, we are to give purgatives freely 

 to enjoin a plain diet, especially abstaining from fer- 

 mented and spiritous liquors ; and, in short, to adopt 

 that system of regimen which is the best calculated to 

 induce a healthy action of the stomach and bowels a 

 circumstance which we are inclined to think is much 

 more important than any direct chemical effect that can 

 be produced on the fluids. The propriety of an opera- 

 tion will depend upon the urgency of the pain, or the 

 other symptoms arising from the mechanical bulk of 

 the stone. We shall only remark, that sometimes a 

 large calculus in the bladder may be borne with tole- 

 rable ease, when, by the use of the proper remedies, it 

 can be prevented from increasing in size ; this proba- 

 bly arises from its more prominent and irritating parts 

 being rounded off, and the organ becoming accommo- 

 dated to its reception. 



SECT. IV. Leucorrhcea. 



We have placed Menorrhagia among the Apocenoses, Leucor- 

 because there is reason to suppose that the menstrual rhcea 

 discharge is, strictly speaking, a secretion ; owing, how- 

 ever, to the nature of its symptoms and treatment, we 

 have enumerated it among the Hamorrhagies, and have 

 given directions for its management in that part of our 

 system. Leucorrhoea, which consists in an increased 

 secretion from the mucous glands of the uterus, is cha- 

 racterized by the appearance of the discharge ; by pain 

 in the loins ; loss of appetite ; general debility ; and 

 wasting of the flesh. The discharge is sometimes of so 

 acrid a nature as to excoriate the parts on which it 

 lodges, and occasionally it even communicates the same 

 symptoms by contact to a second person. 



It is not very easy to ascertain either the exciting or 

 the proximate causes of Leucorrhrea. Whatever stimu- 

 lates the parts in an excessive degree has been conceiv- 

 ed to give rise to the complaint ; but, on the other 

 hand, it has also been attributed to a variety of circum- 

 stances that tend to debilitate the system. Perhaps we 



can be accomplished, must be regarded as the more de- ought to ascribe the affection to general debility, com- 



sirable plan, is by counteracting that state of the diges- bined with local excitement. The debilitating effect of 



tive organs, which gives rise to the disease. Upon the the complaint is much greater than might have been 



whole we may conclude, with respect to this latter expected from the quantity of matter discharged, indi- 



point, that whatever remedies would, in other circum- eating that the complaint is to be referred chiefly to 



stances, tend to improve the process of digestion, and some constitutional action, depending upon the relation 



establish the healthy action of the intestinal canal, will which the uterine system bears to the other parts of 



be equally serviceable in preventing the formation of the animal economy. The complaint is often sympathe- 



calculi. But, besides this general view of the subject, tic of some structural disease of the uterus, and is then 



it wdl be necessary for us to examine the state of the more unfavourable in its prognosis, and often more 



urine in the individual cases of Lithiasis that present distressing in its immediate effects ; but when it exists 



themselves ; because in most of them we can distinctly in its simple form, although, as we have remarked 



perceive the existence of two conditions- of the system, above, it is considerably debilitating, and proves a 



which are very different from each other produce dif- source of much inconvenience, it is seldom to be re. 



ferent effects, and may probably require different reme. garded as dangerous. 



7, 



