LITHOTOMY. 



, Mtcnd the difeafe, however, are confideiMbly alleviated by 

 >licir habitual ufe, and this even when the alkali is faturated, 

 or fnper-faturated with carbonic acid, a circiimftance with 

 regard to which there appears fome difficulty in giving an 

 explanation, fince the alkalies in this Hate have becniluppofed 

 not to aft on the \n-ic acid. But, from the experiments of 

 Dr. E;ran'(Philof. Magaz. vol. 23 awl 24), this appears to 

 he a millake ; though the relief obtained from the ufe of 

 thei'e may alfo be in part derived from the faturation of the 

 other acid, whether phofphoric or acetic, which is iikewife 

 fecreted ; the urine is tlius rendered Icfs irritating, and the 

 tendency to a dcpoiition of uric acid diminilhcd, all acids 

 Iiallenins; the precipitation of this acid from the urine. It has 

 accordingly been found, that under the ufe of alkaline reme- 

 dies, th» fediment of uric acid from the urme, fo often 

 abundant in cafes of calculus, rapidly dimituflies. The in- 

 creafe of the concretion is thus prevented, and the principal 

 caufe of irritation removed. 



So far, therefore, profefTor Murray acknowledges that the 

 alkalies may aft as palliatives ; but he contends, that it mull 

 be very doubtful if they can be given to fuch an extent as to 

 exert an aftual folvcnt power. Befides, there is an effeft 

 which may attend their continued ufe, efpecially in large 

 dofes. It has been remarked by Mr. Brande, that the 

 phofphates of lime and magnefia are held in folution in urine, 

 chiefly by its escefs of acid; if this be faturated, therefore, 

 by the ufe of an alkali, although the depofit of uric 

 ncid may be checked, that of the phofphates will be favour- 

 ed, and it appears that it is principally from a depofition of 

 tliefe that a calculus in the blander increafes in fize. Some 

 cafes, adduced by Mr. Home, appear to fupport this con- 

 clufion. 



Lime, under the form of lime-water, has been employed 

 as a folvent. The experiments of Dr. Egan have ihewn, that 

 lime-water afts with more energy than an alkaline folution 

 of fimilar llrength in deftroying the aggregation of urinary 

 concretions, and Murray found the fame thing. The lime 

 probably operates more upon the albumen or animal matter, 

 which appears to ferve as the cement or connecting fubllance, 

 than upon the uric acid ; and Murray thinks that in cndea- 

 vouriuT to difcovtr folvents for tliefe concretions, our views 

 ought perhaps rather to be direfted to this operation than 

 to tlie effeft on the faline matter. If, fays he, lime, 

 when received into the llomach under the form of lime- 

 water, can be fecreted by the kidnies, as the alkalies unquef- 

 tionably are, it would appear to be fuperior to them as a 

 folvent. But when we confider the fparing folubility 

 of lime , and the fmall quantity of it therefore that can be 

 • brought to the kidnies, the poflibility of its fecretion may 



^e doubted. Mr. Brande has even fuppofed that, v.-ere it 

 fecreted, it would rather prove hurtful, by forming an infohi- 

 ble compound with the phofphoric or carbonic acids, which 

 are always contained in the unue. Murray owns this to be 

 pofTible ; but he argues that if the concretion of thefe fub- 

 itances into a calculus is owing principally to the aftion of 

 the animal matter, fince this mull be prevented, any depolit 

 would be difcharged, and perhaps the aggregation of an ex- 

 iting concretion be destroyed. Under this view, Murray 

 thinks that the proper praftice would be the exhibition of 

 alkali and lime together, the former neutralizing the excefs 

 of acid in the urine, and allowing the latter to exert its 

 power ; and it deferves to be remarked, that the celebrated 

 .Stephens's remedies are a combination of this kind. Cal- 

 culi, compofed of oxalate of lime, phofphate of lime, or 

 phofphate of magnelia and ammonia, not being foluble by 

 .alkalies, the objedt has been attempted by the attion of weak 



acids, like that of lemons. It is quctlionable, however, 

 whether any acid can be given fo as to communicate to the 

 urine a folvent power. Befides, though an acid were to 

 remove the phofphale.s, or at leafl prevent their depoiition, 

 it might promote the formation of uric acid concretions. 

 If, however, the lime-water and alkalies, by operating on the 

 animal matter of calculi, tend to deltroy their aggregation, 

 thele remedies may prove foiv.ewhat uicful in all the varieties 

 of ftone. See Murray's Syftem of Chemittrv, vol. iv. 

 p. 6ji, et fcq. 



Setting afide all chcmiqal reafoning, we are forry to be 

 obliged to coafcfs that praftice does not judify any ftrong 

 hopes of the fufficient efficacy of internal medicines to dif- 

 folve ftones in the bladder. But though lithontriptics are 

 not equal to this effeft, they certainly aifuage the feverity of 

 the fymptoms, which is a benclk of intiniie importance to 

 the afflided. 



Ivledicines conveyed into the ftomach having failed to dlf- 

 fi'lve urinary calculi, various pradlitioners have placed confi- 

 derable expeftation in the plan of introducing a folvent injec- 

 tion through a f atheter directly into the bladder. It will be 

 feen, from the article Catheter in this work, that the an- 

 cients knew how to introduce fluids into the bladder many- 

 centuries before Mr. J. Foot publifhed upon the " Veficpe 

 Lotura.'' Foiircroy and Vauquelin afcertained, that a ley 

 of potaffa or foda, not too ftrong to be fwallowed, foftens 

 and diffolves fmall calculi, compofed of the uric acid and 

 urate of ammonia, when they are left in the liquid a few 

 days. They have proved that ?j beverage, merely acidulated 

 with nitric or muriatic acid, difiblves with Ifill greater 

 quicknefs calculi formed of the phofphate of lime, and of 

 the ammoniacomagncfian phofphate. Tliey have made out 

 tint calculi compoicd of the oxalate of lime, which are the 

 moll difficult of folution, may be foftened ard ulmoil quite 

 diffolved in nitric acid, greatly diluted, pro^ided they are 

 kept in the mixture a fufficient time. We know then liquids 

 that will diflblve calculi of various compafitions ; but much 

 difficulty occurs in employing them effeftually in praftice. 

 For although we can eafily injeft them into the cavity of the 

 bladder, tlus organ is fo extremely tender and irritable, that it 

 cannot bear the contaft of any fluid, except that which it is 

 dcilincd by nature to contain, and the aftion of fuch hquids 

 upon it as would be neceflary to diffolve a itone in its cavity 

 would not fail to produce fuiferings which no man could en- 

 dure, and the moft dangerous and fatal effefts on the bladder 

 itfelf. Another ohjeftion to this experiment is the ignorance 

 iiv which the praftitioner is with regard to the chemical com- 

 pofition of calculi before their extrattion, and of courfe 

 tlieimpoffibility of knowing what folvent ought to beinjeft- 

 ed. Upon this reafon, however, it is unneceirary to lay 

 much llrcfs ; for were the previous more weighty objeftiou 

 done away, the latter difficulty might perhaps be ob- 

 viated. 



Defirable, therefore, as an effeftual lithontriptic is, as it 

 would be the means of freeing the alflifted from the terrible 

 fufferings occafioned by a ftone in the bladder, and of re- 

 moving all occafion for a painful and hazardous operation, 

 it is a melancholy truth that, notwithftanding every expefta- 

 tion, arifing either'from chemical reafoning, from quackifh 

 boafting-S, or from the palliation and temporary relief really J 

 obtained, we have no prafticable means of difiblving a ftone \ 

 in the living bladder. Until this grand difcovery is made, 

 lithotomy will ever be an iudifpenlabie operation, and the 

 views of enlightened iurgeons fhould Hill be direfted to ren- 

 der it as free as poffible from pain and dangerous confe- 

 qiieuccs. 6 



V> e 



