IT often happens that the proper treatment for removing urinary deposits is not adopted in season. In such cases, gravelly particles, finding a lodgment for a time, in the kidneys or bladder, are apt to draw other particles to themselves, which become fastened to them, and form a layer quite around them. Over this, other layers form in succession, until a stone is produced so large that it cannot pass off. These grow to various sizes, being sometimes so large as to fill the bladder.
Uric Acid Calculus. The most common of these formations is the uric acid calculus. It is generally smooth or slightly tuberculated on the surface, and varies in color from a pale yellowish faun to a reddish brown. When sawn through the centre, its layers will be found tolerably regular, but of different thickness. (Fig. 129.),
To test it, place a small fragment upon platinum foil under the blowpipe. If uric acid, it blackens, and gives out an odor like burnt feathers mixed with the oil of bitter almonds.
Mixed Calculus. These calculi are frequently composed of two or more different kinds of matter arranged in irregular layers. Fig. 130 is a mixed calculus, the dark layers being oxalate of lime, the light ones uric acid.
In testing such, fragments of each ingredient should be separately examined.
Urate of Ammonia Calculus. We occasionally meet with a calculus composed of the urate of ammonia. These calculi, when found, are generally small in size, smooth or slightly tuberculated upon the surface (Fig. 131), and of a pale slate or clay color. When heated before the blowpipe, it gradually disappears.
Phosphate of Lime Calculus. This has a smooth polished surface, and quite regular layers, which separate easily when the calculus is cut asunder. It has a pale fawn or stone color. (Fig. 132.)
It chars before the blowpipe, and gradually becomes white as the carbon burns away. Diluted nitric or hydrochloric acid dissolves it without effervescence.
Oxalate of Lime Calculus. This is frequently met with uncombined with others, but more generally its nucleus is uric acid or urate of lime. It commonly has a brown, dark olive, or dirty purple color. Its surface is irregular and somewhat rough. It looks like the fruit of the mulberry, and is known as the mulberry calculu8. (Fig. 133.)
It dissolves, without effervescence, in diluted nitric or hydrochloric acid. When thus dissolved, the addition of a little ammonia win cause it to fall to the bottom as a white precipitate.
Fusible Calculus. This is a mixture of phosphate of lime and the phosphate of ammonia and magnesia. It is the most common of all the calculi, except the uric acid. It has an oval, irregular form (Fig. 134), and is white, soft, and friable, like chalk. Sometimes it is hard.
It may be known by the readiness with which it melts down before the blowpipe, without being consumed.
Causes. The causes of the different kinds of gravel have been already explained. Generally stones of the bladder axe formed in the kidney, and descending through the ureters into the bladder, are pre. vented from passing out through the water pipe by an enlarged prostate gland. Remaining in the bladder, they soon get encrusted over by other matters in the urine, and grow by accretion to be stones.
Symptoms. When a stone in the bladder reaches a certain size, especially ff it is rough, it always produces suffering. A dull, annoying pain is felt at the end of the penis. The desire to make water is frequent, and there is a sense of weight in the perineum. Sometimes the stream of urine is suddenly stopped by the stone falling on the orifice of the urethra. As the bladder becomes nearly emptied, it ces the stone, and the pain is increased. Jolting in a carriage embra causes great pain. Mucus passes off with the urine, and sometimes blood. After a time, the appetite fails, hectic sets in, albumen appears in the urine, and the patient sinks under inflammation of the bladder.
These symptoms being found in diseases of the kidneys and bladder, no one is authorized to pronounce upon the existence of stone, until the stone has been touched by a metallic Sound introduced into the bladder.
Treatment. The only effectual treatment is a choice between three operations, lithotrity, lithotomy, litholopaxy.
The first consists in introducing an instrument, a kind of forceps, into the bladder, through the urethra, taking hold of the stone, and crushing it. The preparatory treatment consists in correcting the unhealthy state of the urine, and the frequent introduction of bougies or sounds to enlarge the water pipe for the easy entrance of the crushing forceps. The after treatment consists in diluent drinks to increase the urine, injections of warm water to wash out the fragments, with hipbaths, soothing injections, and leeches or cupping upon the perineum.
Lithotomy consists in =king an incision into the bladder through the perineum, and taking out the stone or stones whole.
Litholopaxy consists in crushing the stone in Bitu by means of the lithotrite and syphoning out the debris.
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