348 
PAT HO 
of the tin&ure of the muriate of iron. It is in thefe 
cafes that the ufe of opium in fmall doles, of hepatized 
ammonia, and of the magnefia calcinata, (fo ftrongly 
recommended by Dr. Trotter,) feem to be ufeful. 
The common modes by which diabetes terminates when 
the patient dies, are by dropfy, pulmonic difeafe, and 
he6lic fever, or fuddenly, and apparently from nervous 
exhauftion. 
5. Paruria incontinens : incontinence of urine: fre¬ 
quent or perpetual difcharge of urine, with difficulty of 
retaining it. Four varieties. 
a. Acris; from peculiar acrimony in the fluid fe- 
creted. 
/ 3 . Irritata ; from peculiar irritation in fome part of 
the urinary channel.—Difcharge of hairs. Klatt. de Tri- 
chias, Alton. 1703. 
y. Atonica ; from atony of the fphindter of the blad¬ 
der. 
< 5 \ Aquofa ; from fuperabundant fecretion ; the fluid 
limpid and dilute. This variety, which was formerly 
confidered of the fame nature as diabetes, is now properly 
feparated from the complaint, as having nothing in com¬ 
mon with it but an increafe in the quantity of the urine. 
The change which the urine undergoes in this malady 
feems to confift chiefly in the prefence of a great deal of 
albuminous matter. The difeafe is rare ; but, from what 
we can collefl, feems to be clearly one of the nervous; ma¬ 
ladies. Attention to the gaftric and cutaneous fundlions, 
and the relief of the urinal irritability by opium and ful- 
phuric acid, or by hyofcianus, may be for the moll part 
trufted to. 
A peculiar and troublefome difeafe of the urinary paf- 
fage in females is fometimes met with, which, from un- 
willingnefs on the part of the patient to confult medical 
men on the fubjefl, often proves a fource of great dif- 
trefs. It is an inflammatory affection of meatus urina- 
rius. This is firft difcovered by a fevere pain, which ex¬ 
tends upwards during coition, the penis preffing on the 
tender part. As the difeafe advances, the pain is felt on 
making water; and, the paflage fuffering a partial dila¬ 
tation, fome part of the urine is retained in it, and ex¬ 
cites a conftant irritation and defire to make water. The 
difeafe proceeding, fulnefs of the parts is felt, aggravated 
by long continuance in the ereft pofture. If we are 
called in at either of thefe periods of the complaint, we 
lhall afford much relief to the patient by applying 
leeches to the pudenda, and by dire£ling the bowels to 
be kept open, .and a folution of fuper-acetate of lead to 
be ufed as a walh. It is to the above inflammatory Hate 
of this ftrufture that we have to refer the warty and 
fleffiy excrefcences occafionally found at the orifice of 
the meatus. Thefe are to be removed by a ligature, and 
their reproduction prevented by cauftication. 
6. Paruria incofta: urine confiding of fluids taken 
into the llomach, and excreted without change. 
7. Paruria erratica: urine difcharged at fome foreign 
outlet. Five varieties. 
a. Salivaris; by the falivary glands. Phil. Tranf. 1811. 
Cutanea ; by the Ikin. Idem. 
y. Umbilicalis ; at the navel. Ad. Erudit. 1760. 
S. Vaginalis; by a fiftulous opening into the vagina. 
Vulifnerii. Oper. iii. 
e. Perintetica; by a fiftulous opening into the peri- 
nseum- Ibid. ■ 
Genus IV. Lithia, [from XtSo?, a done.] Morbid fe¬ 
cretion or accumulation of calculous matter in internal 
cavities. 
The formation of concretions in the urinary pafl'ages 
being occafioned by the precipitation andconfolidation of 
particular ingredients in the urine, calculi muft of courfe 
be liable to occur in any of the cavities to which the 
urine has accefs. In fad, experience proves that they are 
frequently met with in the kidneys, ureters, bladder, 
and urethra. It is commonly believed, that moft of 
LOGY. 
them are originally formed in the kidneys, from which 
organs they afterwards defcend with the urine into the 
other mentioned parts. We muft however regard as ex¬ 
ceptions to this obfervation, the cafes in which calculi 
are formed round foreign bodies introduced into the 
bladder through the urethra, the digeftive organs, or fome 
accidental wound. In the centre of urinary calculi, bur¬ 
geons have often met with bullets, fplinters of bone, bits 
of wood, pins, See. Nor is it neceffary for fuch foreign 
bodies to be large, in order to produce this effefl : a clot 
of blood, or a little bit of chaff, if not very foon voided, 
will caufe a precipitation of the urinary falts. 
1. Lithia renalis: pain in the loins (hooting down 
towards the teftesor thighs, increafed on exercife ; urine 
often depofiting a fabulous fediment. 
Thefe fymptoms, and the fa£t that Hones have been 
often found ondifleflion in the kidneys when thefe fymp¬ 
toms had preceded death, clearly convince us that it is 
in the kidney that the firft nucleus of the calculi are com¬ 
monly produced. There are two varieties. 
a. Calculofa ; pain fevere and conftant; fabulous dif¬ 
charge fmall and feldom, or never; calculus ufually large, 
and obftrudting the pelvis of an ureter. 
( 3 . Arenofa, gravel; pain intermitting; free difcharge 
of a fabulous fediment. 
Renal concretions vary confiderably in their number, 
fize, and ffiape. In fome cafes, a Angle fmall calculus 
has been found occupying one of the foregoing fixa¬ 
tions; while, in other inftances, an innumerable collec¬ 
tion of calculous fubftances are obferved filling the 
whole of the cavity of the pelvis and infundibula of the 
kidney, diftending its parietes, and even obftrufling the 
paflage of the urine out of thisvifeus, which is converted 
into a fort of membranous cyft. Laltly, a Angle ftone in 
the kidney may acquire a very large fize there ; or a great 
number of fmall calculi, in the fame fixation, may be¬ 
come cemented together by the depofition of frefh con¬ 
creting matter between them, fo as to form one mafs of 
enormous dimenfions, and the fhape of which invariably 
correfponds to the fpace in which it is, as it were, mould¬ 
ed. Hence it is, that renal calculi often prefent a variety 
of odd irregular figures, refembling thofe commonly ob¬ 
ferved in fpecimens of coral. 
Urinary concretions of large fize very often exift in the 
kidney, without their prefence being indicated by any 
external circumftances, or attended with any fymptoms, 
fufficiently unequivocal to conftitute a ground for fuf- 
pedling the importance of their caufe. On the other 
hand, it is very ufual for renal calculi of middling di¬ 
menfions to excite ferious and alarming complaints. 
The reafon of this difference becomes obvious, when it 
is recolle&ed that fmall concretions are readily carried 
with the urine into the ureter, and become fixed in the 
narrow portion of the tube; but very large calculi can be 
contained only in the upper part of this canal, where its 
parietes are more yielding, and the fpace in them more 
capacious. Calculi of middling fize, in their paflage 
through the ureter, caufe at firft a feeling of heavinefs, 
or an indeterminate fenfe of uneafinefs, and an obtufe 
pain in the region of the correfponding kidney. Thefe 
complaints occur at intervals of greater or lefs duration. 
At length, the pain grows more urgent and annoying, 
attended with flatulence, heart-burn, frequent vomiting, 
painful retraftion of the tefticle, and fometimes acute 
fever. The patient makes water frequently, and in fmall 
quantities at a time ; and the urine is high-coloured and 
bloody. The patient cannot fit upright, his body being 
bent forwards towards the affected fide. Thefe fymptoms 
may have more or lefs duration, and then fuddenly ceafe. 
They may alfo fubfide and recur feveral times fucceffively, 
with intervals of fome days. In the latter cafe, the pain 
is felt at each attack to be fixated lower in the track of 
the ureter. Laftly, when the fymptoms have entirely 
difappeared, the urine is more abundant, not fo high co¬ 
loured, and eafily difcharged, the ftream fometimes bring¬ 
ing 
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