URINARY CALCULI. 



5. The tranfvcrfe projeflion of the bladder, between the 

 lower terminations of the ureters, is fomctimes fo confider- 

 able, as to conftitute a kind of partition, and divide the in- 

 ferior part of the bladder into two cavities. From this par- 

 tition, large fungi have fometimes been found projefting, 

 wliich materially increafed ihe depth of the two cavities 

 betwixt which it was placed. In thefe cavities, ftones 

 have been obferved, which were of courfe completely 

 feparated. 



6. Sometimes calculi in the bladder are found to be ad- 

 herent to the inner furface of this organ. The irritation 

 of the foreign body having excited ulceration, fungi arife, 

 which grow into the cavities and irregularities obfervable in 

 fome urinary calculi, and thus produce a mechanical fort of 

 adhefion. 



When the bladder protrudes from the abdomen, fo as to 

 form hernia, a ftone is occafionally fituated in the difplaced 

 portion of that vifcus. It is a circumflance that has the 

 fame effeft as the encyfted Hate of a calculus ; for the 

 foreign body is thereby fixed, and it cannot be propelled 

 towards the neck of the bladder at the period when the 

 urine is difcharged. It fhould alfo be known, that in cafes 

 of prolapfus of the uterus, when the bladder is drawn down- 

 wards, it has fometimes been found to contain a ftone at the 

 loweft part of it. The poflibility of the complication of 

 a calculus, with fuch difplacements of the bladder, ought 

 to be well remembered, fince, if the nature of the cafe be 

 detefted, its treatment becomes materially fimplified. 



The fymptoms of a ftone in the bladder have been de- 

 tailed in the article Lithotomy, and we ftiall therefore not 

 repeat them in the prefent place. They are all fo equivo- 

 cal, and bear fo great a rcfemblance to the effefts of fevcral 

 other difordcrs, that they cannot be depended upon, and 

 confequeutly no furgeon will venture to pronounce pofi- 

 tively, that there is a calculus in the bladder, unlefs he can 

 feel it with a found. (See Searching.) As for the 

 operation, it is always totally unjiiftifiable, if the furgeon 

 cannot plainly feel the calculus immediately before he 

 begins his inciiions. 



The caufes of the formation of urinary calculi is a fub- 

 jeft which is ftill quite obfcurc. The conjectures which 

 have been ftarted refpefting thecff'cft of particular kinds of 

 food, drink, air, &c. do not appear to reft upon a good 

 foundation. We may lay down the following obfcrvations, 

 however, as tolerably correft. 



1. If a foreign body be introduced into a cavity, which 

 is naturally a receptacle for riie urine, whatever may be the 

 nature of the immerfed fubftance, it is lure to become in- 

 crufted with tlie urinary falls, without any change however 

 in its compolition. In this cafe, the obfcrvations of Dr. 

 Marcet tend to prove that the concretion moftly, if not 

 always, confiftsof the earthy phofphatcs, and particularly of 

 the ammoniaco-magnefian pholphate. In this inftance, there 

 is not the leall realon for lufpedting the operation of any 

 peculiar diathefis in producing the calculus, fince the pre- 

 fence of the foreign body, which forms the nucleus for it, 

 would occafion the fame confequence in all defcriptions of 

 patients. 



2. There are fome countries where calculi are exceed- 

 ingly common ; others where they are very rare, and yet one 

 cannot explain the diff^crence by any geographical circum- 

 ftancc v/hich is conllant, or by any particularity in the con- 

 ftitutions of the inhabitants. Calculi are found to be un- 

 common both in very cold and very hot countries. 



3. When the urinary organs arc not much injured, pa- 

 tients with ftone may be healthy in every other rcfpcft. 



4. Subjefts, indeed, gifted with the ftrongeft conftitu- 

 tions, are liable to urinary calcuh, quite independently of 

 the accidental introduftion of any foreign body into the 

 urinary organs. In thefe cafes, the origin of the complaint 

 is to be afcribed to a peculiar diathefis, the nature of which 

 is at prefent entirely unknown. 



5. Women have been thought to be lefs liable than men 

 to urinary calculi ; but yet it is a point which is by no 

 means certain. The qucftion, indeed, ftill continues thus : 

 Are women in reality lefs liable than men to urinary calcu- 

 li ? Or do they only fuffer lefs frequently from the ilifordcr 

 in confequertce of the facility with which the calculi are ge- 

 nerally diicharged through the fhort and capacious canal of 



the meatus urinarius ? 



6. Childhood and infancy prefent numerous inftances of 

 urinary calculi ; but, according to Delpech, relapfes are 

 feldom obferved at thefe periods of life : that is to fay, an 

 entirely frefti ftone is hardly ever formed again. If a return 

 of the complaint happens, the quicknefs of the recurrence, 

 and an attentive examination of the calculus, will in general 

 fufSciently prove, either that the ftone has formed round a 

 fragment which had not been extrafted in the previous 

 operation, or that it was already completely formed at the 

 fame period, but inadvertently left behind. 



On the fubjeft of the frequency of the ftone in children, 

 Dr. Marcet thinks that this is the cafe only among the poor 

 clafles. He remarks, that in the higher ranks, or even in 

 the loweft clafTes, provided they are well fed, the fame fre- 

 quency is not obferved. " In the Foundling Hofpital, for 

 inftance, within the laft twenty-feven years, during which 

 lijl children have been admitted, only three cafes of 

 ftone have occurred, all of' which were among childreii 

 while at nurfe in the country. And in the Military 

 Afylum at Chelfea, which contains about 1250 children, 

 and into which upwards of 6000 of them have been al- 

 ready admitted, no more than one fingle cafe of ftone 

 has occurred." See Marcet's Efl'ay on Calculous Dif- 

 orders, p. 36. 



7. Youths and adults are not very commonly troubled 

 with calcuh, even tliough they may have been thus a/flifted 

 in their infancy or childhood. 



8. Old men are much more liable to the diforder, and in 

 them the difpofition to it continues through life. Hence, 

 in fnch patients, relapfes are very frequent. Delpech, 

 Precis Elcm. des Mai. Chir. t. ii. p. 193, &c. 



Of all the writers who have inveftigated the caufes of 

 urinary calculi, none have intcrefted us fo much as Dr. 

 Marcet. This able phyfician has endeavoured to eftimate 

 the comparative frequency of the difcafe in various countries, 

 and in the dift'erent ftations of life, and to determine 

 whether its frequency be influenced by varieties of climate 

 or fituation, or by peculiarities in our habits and occupa- 

 tions. He inftituted inquiries at all the great hofpitals of 

 the metropolis, in the hope of getting at fome ufeful records 

 concerning the vail number of patients on whom lithotomy 

 had been performed in thofe eftablifliments. In London, he 

 found it impoITible to obtain all the particulars of fuch cafes, 

 as no entry of them was preferved. The Norwich hofpital, 

 however, afforded him fome details, wiiich arc interefting. 

 All the calculi, which have been extrafted in that holpital 

 for the laft forty-four years, and which amount to jo6, 

 have been carefully preferved, with the circumftances an- 

 nexed to each ftone, and the event of the operation diftinftly 

 recorded. Dr. Marcet has given the refultn of thefe records 

 in the following tabic : 



Returns 



