CHAPTER VII. 



The Abdomen — Continued 



THE URINARY ORGANS. 

 Urolithiasis 



The formation of free concretions in the urinary tract is of 

 fairly common occurrence. It is believed to depend upon two 

 factors, viz., a Systemic alteration or modification of metabolism, 

 and a Local alteration in the urinary tract. It is believed that 

 there must exist a primary organic nucleus around which the cal- 

 careous salts become deposited, or in other words, calcification is 

 secondary to, and dependent upon, local degenerative tissue 

 changes. Such lesion occurs in the healthy aseptic gland second- 

 ary to primary uric acid diathesis. Uric acid is a chemical poison, 

 and according to Ebstein, its excessive elimination originates an 

 inflammation which results in cellular necrosis. Such necrosed 

 cells or the albuminoid substance to which their destruction gives 

 rise, form the organic nucleus. 



Antoine de Heyde, in 1686, was the first observer to note the 

 presence of the necessary nucleus, and more recently various ex- 

 periments have been carried out to ascertain the manner in which cal- 

 culous formation takes place. Tuffier conducted certain of these ex- 

 periments and observed that aseptic smooth foreign bodies were not 

 modified by a sojourn in healthy urinary passages, neither did the 

 organ enclosing them undergo any alteration by their presence. 

 These results impelled him to study the conditions under which 

 extractive matters of the urine are precipitated on the surface of 

 foreign bodies to form calculi. In order to do this he produced 

 varied chemical composition of the urine. Nitrogenous and phos- 

 phatic diet and ingestion of urates and oxalates produced no result 

 when sterile glass marbles were introduced in the kidney and 

 bladder. Nicolaier and Ebstein and Thomassen endeavored to 

 produce artificial lithiasis by incorporating derivatives of oxalic acid 



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