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THE

QUARTERLY JOURNAL,

January, 1820.

ART. I.

Observations on the Medico-Chemical Treatment of Calculous Disorders, by William Thomas Brande, Sec. R. S., &c. Continued from page 72.

SECTION III. On Calculi of the Bladder; their Nature and Treatment.

THE last division of this subject relates to calculi of the urinary bladder: their history, as connected with my present object, may be detailed under the heads of their composition and formation, and their symptoms and treatment.

The chemical constituents of these calculi, have already been enumerated, and their leading characters pointed out; they are

Uric acid.

Ammonio-magnesian phosphate.
Phosphate of lime.

Oxalate of lime.
Cystic oxide.

But their formation will require a more extended inquiry. From what has been formerly stated, when speaking of kidney calculi, it will appear obvious that the most common proximate cause of cystic calculus is the lodgment of a small uric calculus in the bladder, since the majority of kidney calculi are formed of that substance.

Such a nucleus being lodged in the bladder, it rarely happens VOL. VIII.

Р

that it remains for any time without undergoing an increase of bulk, the nature of which will chiefly depend upon the state of the urine, which, if charged with uric acid, will deposit it in layers, thus causing the growth of the calculus in that substance; or if there be no excess of uric acid, the deposition will be of the phosphates. Accordingly, bladder calculi are sometimes almost entirely composed of uric acid, while at others the nucleus only is of uric acid, and the bulk of the stone consists of the triple phosphate of ammonia and magnesia, and phosphate of lime, forming the mixture which Dr. Wollaston, in his valuable paper, has termed fusible calculus; (Phil. Trans. 1797,) and in which the ammonio-magnesian salt generally predominates.

It deserves notice, as throwing considerable light upon the formation and growth of cystic calculi, that the urine has at all times a tendency to deposit the above-mentioned phosphate upon any body over which it passes: drains by which urine is carried off from the streets, &c., are often incrusted with its regular crystals; and in cases where extraneous bodies have got into the bladder, they have often in a very short time become considerably enlarged by the deposition of the same substance. If, from any cause, the urine becomes in the slightest degree putrid, ammonia is evolved, and the deposition of the phosphates much accelerated and increased. These, as we shall afterwards show, are facts that require always to be borne in mind, as influencing the mode of treatment to be adopted in respect to bladder calculi in general.

The appearance of the triple phosphate is more or less crystalline, and the calculi incrusted with it are generally grayish white. Strongly heated before the blow-pipe, this substance evolves ammonia, and with much difficulty enters into an imperfect fusion; if, however, phosphate of lime be present, it more readily undergoes fusion: hence the propriety of the term fusible calculus applied to the mixture of the two phosphates.

Calculi, composed entirely of the ammonio-magnesian phosphate, are very rare; I have seen two; they were crystallized