PATHOLOGY. 347 
ing out with it the urinary concretion, which has now 
entered the bladder. 
Suppuration of the kidney, and an abfcefs in the lum¬ 
bar region, in confequence of renal calculi, are not very 
common events. This, however, is the only cafe of the 
kind, in which the interpolition of furgery can be ufeful. 
By adverting to previous circumftances, and the irregu¬ 
larity of the pain about the kidney, the pradlitioner may 
fufpedl the nature of a phlegmonous tumour in the fitu- 
ation of this vifcus. Whatever may be his conjedlures, 
however, he mull carefully abftain from the ufe of his 
lancet, until purulent matter is obvioully under the inte¬ 
guments. He may then fafely make an opening, from 
which urine and pus will be difcharged, and through 
which the calculi themfelves may fometimes be felt and 
extracted. But it is quite clear, that no operation for 
the extradlion of calculi, by means of incifion or other 
violent methods, can be fafely attempted on fo vafcular a 
part as the kidney. Tt is only, therefore, when (on 
opening the abfcefs) calculi can be felt with a probe, 
that an attempt may be made for their extraction. 
Calculi are fometimes found in the ureters, efpecially 
at their upper part; but it is not fupp'ofed that they are 
in general originally formed in that fituation ; an event 
not likely to happen, unlefs there be fome caufe obftruft- 
ing or retarding the defcent of the urine through thofe 
tubes. The common belief is, that all calculi found in 
the ureters are firft produced in the kidneys, from which 
they afterwards defcend in the courfe of the urine. The 
generality of calculi, however, which leave the kidney, 
are of fmall fixe; and confequently, after a time, and 
exciting fome pain and inconvenience, they ufualiy get 
into the cavity of the bladder. 
z, Lithia veficalis, ftone in the bladder : frequent de¬ 
fire of making water, with difficulty of difcharge : penis 
rigid, with acute pain at the glans; fonorous refiftance 
to the found when fearching the bladder. 
The form of calculi is various. Commonly they are 
fpheroidal, egg-fhaped, or oval flattened at the Tides. 
They alfo receive fome variety of form from the iinpref- 
fion of other calculi. In a few inftances, they have been 
found of an angular or entire figure, or of a fliape corre. 
fponding with the pear-fliaped form of the bladder, a 
circular protrufion anfwering to the neck of that cavity. 
The number and fize of calculi are alfo liable to fome 
variation, as may be feen by referring to the following 
inftances which we are indebted to Dr. Good for pointing 
put.— Voided of the weight of z oz. by a female; Hanow, 
Seltenheiten der Natur.— z\ oz. troy by a female; Moll - 
neux. — 5 oz. by the penis; Samwlung Med. Wahrn, Band 
viii. p. 238.— Extracted, 12 oz. weight ; Chefelden, Anat. 
Ephem. Nat. Cur. Dec. II. ann.v.— zz oz. Fair. Hi/d. de 
Lith. vefic. Cent. iv. obf. 51 : the patient died during 
the operation— Found in the bladder, 4flb. weight; Brtjl. 
Summtung, 1724, ii. 434- 11.—In the bladder of a dog if lb. 
Eph. Nat. Cur. II. Dec. III. ann. v. vi. p. 99.— Nearly 
jib. in the bladder of a horfe; Gattenhof, in Diffi de 
Cal. 1748.—2 to 3 oz. Phil. Tr. vol. xv. p. 1015.—The 
number of 120 of various fizes voided in the courfe of 
three days. Eph. Nat. Cur. Dec. III. ann. v. vi.—300 
large in two years. Fabr. Hild. cent. i. obf. 69.—2000 
within two years. Gr'undlicher Bcricht. vom Blatterftein. 
The fymptoms of ftone in the bladder are very obfcure. 
They are often fimulated by irritative maladies, and 
moll efpecially by the nervous excitement confequent on 
indigeftion. So marked and eftabliflied is the fimilarity 
between dyfpeptic nervous affedlions and the particular 
fenfations of the bladder, that on many occafions not the 
flighte.fi queftion could be entertained by the inexperi¬ 
enced pradlitioner of the prefence of calculi, were it not 
that the found gives no indication of it. Scirrhus of the 
reflurn, and diieafed proftate, are difeafes which refemble 
the complaint in queftion in fome refpedls. 
The following is the hiftory of the ordinary fymptoms 
of Lithia veficalis. The pain produced by the prefence 
Vox. XIX. No. 1308. 
of a calculus in the bladder, has the particularity of 
always affedling, in a very remarkable manner, the ex¬ 
tremity of the penis. The glans becomes the feat of an 
itching fenfation, which daily increafes in violence ; and 
patients, efpecially children, often get into the habit of 
pulling forwards the prepuce, in order to obtain relief. 
Hence, this part is frequently elongated in an extraor¬ 
dinary degree. This lympathetic fort of pain is more 
acute the larger the ftone is, and the greater the irregu¬ 
larity of its lurface. When the bladder is full of urine, 
the pain is not infupportable; but, juft at the period 
when the difcharge of that fluid is finiftied, the fuft’ering 
becomes intolerable, becaufe, at this inftant the bladder 
contradls, and embraces the foreign body with confider- 
able force. All rough exercife augments the pain; but 
walking over an uneven country, riding on horfeback, 
and the jolting of a carriage particularly, have fuch an 
effedl. When the patient is fubjedled to thefe exercifes, 
he not unfrequently difcharges a few drops of blood from 
the urethra. The defire to make water comes on very 
often ; and the urine, as it flows, is attended w'ith a fen¬ 
fation of heat, which changes into a burning kind of pain 
at the extremity of the penis. The ftream of water is 
fometimes interrupted all on a fudden. The patient 
v.finly endeavours to continue the evacuation ; he ap¬ 
plies his hand to the perineum ; he moves about, lies 
down, or, in fome way or another, alters his pofture, and 
the urine then begins to run again. The moveablenefs 
of the ftone makes it every now and then fall againft the 
orifice of the neck of the bladder, and thus prevent, for 
a time, the exit of the urine. The inceflant irritation, 
produced by the prefence of the calculus, extends to the 
redlum ; the patient is continually teazed with an incli¬ 
nation to go to (tool, and the efforts, which his imagi¬ 
nary want caufes him to make, bring on, in many in¬ 
ftances, hemorrhoidal complaints, or even a prolapfus ani. 
But, as we before remarked that all thefe fymptoms are 
equivocal, the pradlitioner fhould always introduce a 
found into the bladder before he gives an opinion on the 
nature of the cafe. For the mode of founding, fee Sur¬ 
gery. 
Having thus detailed the fymptoms which calculous 
depofitions are accompanied with, and defcribed the va¬ 
rious fituations they occupy, and the extreme magni¬ 
tude or number they may acquire, we proceed to confi- 
der their eompnfition, with reference to their removal by 
medical fkill. In this talk we fhall make no diftindlion 
as to the fituation the calculi occupy, or their fize; fince, 
whether they exhibit the form of gravel or of ftone, their 
compofition is analogous. 
We fhall clafs urinary depofitions in the following or¬ 
der. 1. The lithic or uric acid depofition, being an ex- 
cefs of the natural free acid of the urine. 2. The de¬ 
pofitions of which phofphoric acid forms a part; viz. 
the phofphate of lime or bone-earth calculus; the ain- 
moniaco-magnefian phofphate : and a mixture of the 
two latter, called the fufible calculus. 3. The oxalate 
of lime. 4. The cyftic oxyd. 5. Compound varieties. 
As to the formation of all thefe various matters, fome 
of which are proper to urine in its healthy Hate, and fome 
of which are peculiar to its morbid ftate, little can with 
certainty be faid. Chemical philofophers have endea¬ 
voured to fhow, that a diet which contains a large por¬ 
tion of azote, as animal food, produces excefs of alkali 
in the urine ; and fimilar fpeculations have been founded 
on the effects of vegetable food. Further than the fadt 
that an exclufive fpecies of diet tends to derange the gaf- 
tric fundlions, and that a change quite oppofite muft ne- 
ceflariiy change many of the operations of the fyftem, 
we cannot admit the corredlnefs of any obfervations of 
this kind. In fadl, contrary to what wefhoulda priori 
expedt, and contrary to thefe obfervations, we do not find 
that people who drink plentifully of waters ftrongly im¬ 
pregnated with falts are more difpofed than others to 
calculous complaints. We are much pleafed to find, that 
4 U the 
