Part 15
"_The alternating calculus_, as the name imports, may consist of different layers of any of the preceding species. Hence its general appearance, texture, &c. will depend entirely on the composition, and may be very varied. Most commonly it is composed of a lithic acid or mulberry nucleus, and an external crust of the fusible calculus. In some rare instances, it is composed of laminæ of all three of these substances, and sometimes of even more--the mixed phosphates still continuing to constitute the external crust. This species of calculus often acquires a very large size and is very common.--_Chemical characters._ The chemical characters must of course vary with the composition; and as the different substances of which it is composed must almost certainly be some of the preceding, the nature of the different laminæ can be readily ascertained by what has been already stated," p. 79, et seq.
In the chapter on the comparative prevalency of different forms of urinary deposite; and the order of their succession, we have a number of important facts and observations. Dr. PROUT calculates, from the data collected by him, that about one-third of the urinary calculi which occur, are of the lithic acid species, and that another third are formed on a nucleus of this acid. Hence, "we may assert," says he, "that at least _two-thirds_ of the whole number of calculi originate from lithic acid; that is to say, if a lithic acid nucleus had not been formed and detained in the bladder, two persons at least out of three, who suffer from calculus, would have never been troubled with that affection. This is a most important fact, and deserves to be constantly borne in mind."
The relative prevalency of the oxalate of lime calculus is very various. The average proportion, as determined by Dr. PROUT is about one in seven. Of the calculi, examined by Mr. BRANDE, 1 in 25 was of the mulberry species; while in the Norwich and Guy's Hospital collections, the proportion is about 1 in 4. In the Bristol collection, one-sixth of the whole, was composed of oxalate of lime, nearly pure; while, including all the concretions containing more or less of the oxalate, the proportion was nearly _one-half_! This great disparity in the proportional frequency of this calculus in different districts of England, clearly shows the great influence of local causes, in determining the character of urinary concretions.
From a careful observation of the order of deposition of different species of calculous matter, Dr. PROUT has been enabled to deduce the following general law; "_that, in urinary calculi, a decided deposition of the mixed phosphates is not followed by other depositions_." So that it would appear, that a redundancy in the earthy phosphates is the last link in the chain of diseased alterations, to which the urinary secretion is liable.
In the third chapter, under the second subdivision of functional urinary diseases, Dr. PROUT describes the lithic acid diathesis, and communicates several important original observations. After remarking that the dyspeptic are particularly predisposed to lithic acid deposites, he enumerates, as exciting causes of this species of gravel, 1st. _Errors in diet_; 2nd. _Unusual or unnatural exercise of the body or mind, particularly after eating, and the want of proper exercise at all other times_; and 3d. _Debilitating causes_. Under errors of diet, an unusually heavy meal, especially of animal food, and the use of heavy, unfermented bread, or compact, hard-boiled, fat dumplings or puddings, salted and dried meats, acescent fruits, malt liquors, and acescent wines, are enumerated as particularly hurtful in the lithic acid diathesis.
The above remarks refer to the amorphous lithic deposites, consisting of lithate of ammonia. In regard to crystallized sediments, or, more properly speaking, gravel, our author makes the following remarks:
"Crystallized sediments, or red gravel, consist of lithic acid, nearly pure. Lithic acid, as has been before stated, exists in a state of combination in healthy urine; and in such a proportion, as to be held in a state of solution at all ordinary temperatures. Sometimes, however, a free acid is generated by the kidneys, which precipitates the lithic acid in the pure crystallized state we see it--a phenomenon easily imitated artificially, as is well known, by the addition of a few drops of any acid to healthy urine. The precipitation of crystallized lithic acid does not, therefore, necessarily indicate an excess of lithic acid in the urine, but the presence only of some free acid in that fluid; though such an excess does, for the most part, exist in this form of disease, as will be shown hereafter. With respect to the nature of the precipitating acid, it is probably not always the same. Most generally it appears to be the _muriatic_, sometimes the _phosphoric_ or _sulphuric_, and occasionally other acids. In general, however, it is to be understood, as noticed elsewhere, that when the mineral acids are present in excess, these are the _immediate_ cause of the preternatural acidity in the urine, and consequently of the precipitation of the lithic acid. The stronger acids act by decomposing saline compounds, into which destructible acids, such as the lactic acid, &c. enter, and setting them free. Hence the _immediate_ cause of the deposition of lithic acid gravel is generally a destructible acid of very weak powers: even, perhaps, in some instances, the carbonic acid. When the urine contains a free acid, it is commonly more transparent than usual, and of a bright copper colour." p. 112.
The treatment recommended by Dr. PROUT in this species of gravel is as follows: First, a strict attention to diet, avoiding the hurtful articles already enumerated. Secondly, the use of _alkaline_ remedies; but those must not be depended upon, without the aid of other means, more especially of alteratives and purgatives. Accordingly we are informed that
"The pil. submur. hydrarg. comp., or a pill composed of the pil. hydrarg. and pulv. antimonialis, may be taken twice or thrice a week at bed time, and followed up the next morning by an active dose of the sub-sulphate of magnesia, or a mixture of Rochelle salts and magnesia, or carbonate of soda. A little of either of these compounds may be also taken twice or thrice in the day, so as to keep the urine constantly neutral or alkaline, and the bowels freely open; or gr. x to xx of magnesia may be taken for the same purpose in a glass of soda water, as often as it may be found necessary."
In the chapter on the mulberry, or oxalate of lime diathesis, Dr. PROUT gives a number of cases, from which he draws the following conclusions:
"1st. That this form of disease occurs in both sexes; that it may exist before puberty, and at all ages between that and 40 or 50, at which time it seems to occur most frequently; but that no case occurs beyond the age of sixty. Hence that it is probably not a disease of old age.
"2nd. That it is not incompatible with gout, but seems occasionally to be associated with it. I have also seen it connected, as lithic acid frequently is, with a tendency to cutaneous disease.
"3d. That this variety of calculous affection occurs in individuals of sound constitutions, and who ordinarily enjoy good health; and that it rarely occurs a second time, except at long intervals, during which the intermediate health is good; which latter facts, it may be proper to observe, are confirmed by other observers, and particularly by Mr. BRANDE and Dr. MARCET.
"4th. That the urine is acid, and apparently but slightly deranged in this form of calculus, and remarkably free from all sorts of sediment and gravel.
"5th. That as renal calculi of the oxalate of lime often subsequently acquire considerable magnitude in the bladder, it may be inferred, that the formation of this compound is connected with a distinct diathesis, excluding the existence of other diatheses, and that is not an accidental occurrence, happening in common with many others to the urine.
"6th. That from the dissection of calculi, formerly mentioned, it appears that the oxalate of lime diathesis is preceded and followed by the lithic acid diathesis; a circumstance which seems to be peculiar to these two forms of deposite, and which, when taken in conjunction with the other circumstances, already related, appears to show, that they are of the same general nature; or in other words, that the oxalic acid merely takes place as it were of the lithic acid, and by combining with the lime naturally existing in the urine, forms the concretion in question.
"7th. That the diathesis being of a similar nature, the principles of treatment adapted for counteracting the original tendency to it must be also similar, that is to say, of an antiphlogistic character; great attention being at the same time paid to the digestive and assimilative functions." p. 137, et seq.
The diagnostic signs of the oxalate of lime diathesis are very obscure, as will appear from the following extract:
"With respect to the means of determining when this diathesis is going on in the system, I am sorry that I can give but little positive information. The absence of urinary sediment, &c. are of a negative character, and lead to no inference, where other circumstances are wanting, as is most generally the case. But if there be pain in the region of the kidney, and other symptoms of gravel, without any appearance of sediment; and if the urine be acid, and of the yellow tint above alluded to, the stomach deranged, and an inflammatory diathesis, either general or local (i.e. about the urinary organs), be present; and if all these are associated with suppressed gout, or tendency to cutaneous disease,--the existence of this form of the disease may be suspected, and means immediately taken to counteract it." p. 138.
We omit any analysis of the next chapter on the cystic oxide diathesis, on account of the rare occurrence of this state of the system.
The next chapter of our author is on the phosphatic, or earthy diathesis.
The phosphatic deposites are of two kinds; the _crystallized_, consisting almost invariably of the triple phosphate of magnesia-and-ammonia, and exhibiting the appearance of white, shining crystals; and the _amorphous_, consisting always of a mixture of the phosphate of lime, and the triple phosphate of magnesia-and-ammonia.
The causes apt to produce a deposition of the triple phosphate of magnesia-and-ammonia, are thus enumerated by Dr. PROUT:
"Any thing acting generally, and producing _a nervous state of the system_, such as the distressing passions, and particularly _mental anxiety_ or _fear_, will frequently produce in many people an excess of this salt in the urine. The same is also true of many articles of food or medicine that produce a hurried secretion of the urine, and act as diuretics; as the neutral salts in some cases, and particularly the Rochelle salts and other saline compounds, in which the acid is of vegetable origin. So also, a long continued use of alkaline remedies, or of mercury, in irritable habits more especially, will likewise produce a tendency to an excess of this salt, as well as of the phosphates in general, and even lead to an actual deposition of them from the urine. The same sediment also frequently abounds, or is easily induced, in the urine of those who have long been in bad health, and in whom the constitution may be considered as giving way, or, to use a common expression, breaking up. In general, it is to be understood, that the slighter causes affect only the predisposed, and those in particular who are subject to other diseases of the urinary organs or urine. It may be also remarked, that children are more subject to this form of deposition than adults; a circumstance, perhaps, to be referred to the irritability of the system at this age, and the great derangement of the digestive organs, to which they are subject." p. 151.
The above mentioned causes are stated to be equally productive of amorphous phosphatic sediments.
Our author next enumerates the very distressing symptoms, by which the deposition of the earthy phosphates is attended. They consist in great irritability; derangement of the chylopoietic viscera, evinced by flatulency, nausea, obstinate costiveness, or peculiarly debilitating diarrhoea; extremely unnatural stools, nearly black, or clay-coloured, and sometimes resembling yest; pain, uneasiness, or weakness in the back or loins; sallow, haggard expression of countenance; and finally, if the disease be not arrested, great languor and depression of spirits, coldness of the legs, and complete anaphrodisia, as occur in diabetes.
A curious and important fact has been stated in regard to the remote causes, producing the phosphatic state of the urine. It has been observed by Dr. PROUT, that a large proportion of cases of this complaint may be traced _to some injury of the back_ from mechanical violence, such as a fall from a horse, &c.
The remedies for this diseased state of the urine, found most successful by Dr. PROUT, are,--opium, in from one to five grain doses, repeated two or three times a day, until the unnatural irritability of the system is relieved,--the same remedy in more moderate doses, in conjunction with the mineral acids, cinchona, uva ursi, and the different preparations of iron,--a large pitch, soap, or galbanum plaster to the loins,--and setons or issues in the back, when the disease manifestly arises from local injury. With respect to the bowels, Dr. PROUT remarks, that they are very difficult to regulate. He has occasionally seen serious consequences to arise from the exhibition of a small dose of calomel, such as diarrhoea and debility, much aggravating the disease, and endangering the life of the patient. For the regulation of the bowels, small doses of castor oil, and laxative injections are most to be relied on; while saline purgatives, more especially Rochelle salt and Seidlitz powders, as containing vegetable and therefore destructible acid, must be avoided.[24] Mercury, in all its forms, is also inadmissible.
"Alkaline remedies of every description, must be most carefully avoided, their use in every point of view being most mischievous when the phosphates are concerned. Indeed all remedies that act as diuretics should, in general, be shunned, and the patient should be prohibited from drinking too much. With respect to drinks, in general, they should be of a soothing, demulcent character, and prepared with distilled or the softest water that can be procured; as hard waters are literally poison in this form of disease."
The second division of the work under review treats of the mechanical and organic diseases of the urinary organs. This portion of the subject is handled with the same ability as the first. We regret, however, that our space will not permit a further development of the author's views. We trust, nevertheless, that we have imparted to our readers adequate notions of the scope of the work, to render them sensible of its value as a manual of urinary diseases. It is illustrated by a good coloured plate, representing the principal varieties of urinary calculi.
The additions of Dr. COLHOUN consist of foot notes, and paragraphs inserted in the text of the original work. We would not, however, wish to be considered as approving of the course, for the most part pursued by Dr. C., of inserting his amplifications in the text of the author, merely distinguished by brackets. Besides the absence of sufficient distinction between the matter of the author and commentator, the text of the former is thus injuriously disjointed, and dependent sentences sometimes widely separated.
In regard to the execution of the present edition, we regret to say that it is wanting in typographical accuracy.
FOOTNOTES:
[23] The reader will bear in mind, that this acid is the same as the uric, the name by which it is generally known.
[24] The reason of this exclusion of salts, containing a vegetable acid is, that they become real alkalies in the course of assimilation by the destruction of their acid, and therefore add alkaline properties to the urine, already too alkaline.
MEDICAL LITERATURE.
ARTICLE XII.--RETROSPECTIVE REVIEW.--_Tractatus de Ventriculo et Intestinis, cui proemittitur alius, de Partibus continentibus in Genere, et in Specie de iis Abdominis._ _Authore_ FRANCISCO GLISSONIO, &c. &c. Lond. 1677, 4to.
As it is not our intention to confine our remarks to the work above mentioned, we shall deem no apology necessary for the somewhat excursive nature of this article, which would not answer our present purpose, if we were obliged to follow the costive details of the venerable FRANCIS GLISSON, whose villanous bad style, and execrable latin, are only to be excused or overlooked in consideration of the great importance of the topics which he handles, and the profound reflections which he makes on them. GLISSON is recognised as author of the physiological term _Irritability_, and as the assertor of the inherent activity of matter. HALLER says of him in his XIth book. "FRANCISCUS GLISSON, qui universis elementis corporum, vim motricem tribuit, etiam nostram vim, Irritabilitatem vocavit," &c.
He was a native of Dorsetshire, and was appointed professor of physic at Oxford in 1627. This post he occupied during forty years, and is much distinguished by his treatise de vita naturæ, and by the work which forms our caption. As he is the first who used the physiological term irritability, we have thought that some researches on this subject in general, and more particularly on his peculiar sentiments, might profitably occupy our retrospective department; for it is very evident that this subject is in general but vaguely discussed, both in medical writings and conversation.
The ancient philosophers did not agree among themselves as to the nature and origin of matter; some of them considering it as eternal in its essence, and others as mutable and changeable in form. The theory of atoms, published by DEMOCRITUS, and subsequently carried out so elaborately by EPICURUS and his disciples, seems to have reached even to our own times, with an increasing reputation and acceptance. According to this theory, the kinds of matter, or elements, must he regarded as infinitely various. HERACLITUS, who taught philosophy about 550 years before Christ, considered all things as derived from an elemental heat or fire;[25] a philosophy which seems to us to have formed the basis of the Hippocratic doctrines of life. Like HERACLITUS, HIPPOCRATES tells us, that the calidum was the first principle of things, and that by an expansion or extension of itself, it constitutes all the objects of the material world. He expresses himself in the following manner. That which we call warmth, or heat, seems to me to be something immortal; something which comprehends all things, which sees and knows all things, as well present as future. Thus assuming as a basis, that the calidum is an almighty, all-wise being, or in other words, a God, all in all, the cosmogony was developed as follows: Chaos he regarded as that condition of the calidum, which preceded any exertion of the Almighty faculties. In emerging from the chaotic state, the greatest part of the heat having assumed the uppermost place, formed the æther; another part having gained the lowermost place, constituted earth; a third portion, midway between earth and æther, became air; and a fourth part, establishing itself between the two latter, became water. So that by means of the extension of this all-wise, elemental calidum, we have the four elements, earth, air, fire, and water, out of which are ultimately composed all the aggregates of the material world.[26] Now, to apply this general principle to the formation of the living being man, who seems to be a sort of microcosm in himself, we are told, that that portion of heat which remained with earth, being expanded and spread abroad in divers places, in some more, in others less, the earth became dry, and something like membrane or pellicle was formed; the matters contained in which, being heated as by a sort of putrefaction, some parts became bone, some nerve, some veins and their contents, and some formed the cavities and their contents, as the urinary bladder, for example.[27]
The full exposition of the opinions of HIPPOCRATES was left for GALEN, and we prefer to make reference to him on this theory, which by his genius and talent was so much embellished, that it became the glory of science, exercising an almost undisputed authority during a long lapse of ages. Indeed the gigantic intellect of this great man, still continues to shed its vast illumination over the world of science, particularly that of medicine; which, if it owes its birth to the divine old man of Cos, is not less indebted for its nurture and growth to the celebrated native of Pergamus. GALEN is the facile princeps of physicians. His astonishing industry, perseverance, and acquirements, his ingenious arguments, and persuasive eloquence, give him an unquestionable claim to the title of princeps, so long accorded to him; and those who even in the present enlightened period, will study his works, shall find themselves almost irresistibly led away by the charm of his suasion.
GALIEN est le seul des anciens qui ait donné un corps complet de medecine: Quoique formé des débris de toutes les doctrines précédentes, son systeme offre cependant, malgré les contradictions ou il tombe assez souvent, une unité remarquable dans toutes ses parties; un ensemble séduisant, qu'un genie de l'ordre le plus élevé pouvoit seul imprimer à un pareil édifice. Ramenant tout à un petit nombre de principes généraux, qui s'ils ne peuvent satisfaire la raison, fournissent du moins une réponse facile a tout, ce systême dut être adopté avec empressement, et sa fortune ne peut étonner.--_Biographie Medicale, Tom. IV._
GALEN may perhaps be justly regarded as an eclectic; but it is manifest, that he mainly walked after the steps of his great predecessor, and recognised model. The following passage seems to contain ideas not much differing from those of HIPPOCRATES which we have presented above: "Who is there, says he, that judging from the origin and constitution of animated beings, doth not immediately infer the existence of a mind, possessed of wonderful energies, extending to, and pervading every portion of the universe! We every where perceive animals procreated, which are possessed of the most admirable structure, and yet what portion of the universe can be more ignoble than this earth of ours? Yet a grand intelligence is seen to have reached even it from the celestial bodies, which for their beauty are so astonishing, and which, as they are for purity far more excellent than our earth, so they are the seats of intelligences, far more pure and perfect than those which inhabit these lower regions." He proceeds to remark, that animals, worthy of the greatest admiration, are produced out of the slime and mud of ponds and ditches, and even in putrefying vegetables, which, as they indicate the miraculous properties of their author, also show us in what estimation we should hold the higher orders of being. "We may even perceive a rational nature in men, if we refer to such examples as PLATO, ARISTOTLE, HIPPARCHUS, ARCHIMEDES, and many others. If, therefore, in such a colluvies as the human body, (for by what better name can we characterize a mixture of blood, bile, and phlegm,) a mind is formed of such great and excellent faculties, what must we think of the excellence of that which exists in the superior bodies?"