STONE

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STONE, or CALCULUS ; every hard concretion, not bony, formed in the body of animals. The article Calculus treats of the variety and chemical composition of these concretions. We shall add here a few words respecting their probable origin, and the cure of this disease in man. These concretions originate immediately in a disturbance of the secretions; but this disturbance may, perhaps, in most cases, be caused by a disordered condition of the juices, particularly of the bloody and a want of due assimilation. This may be supposed, because, in the complaints of the gravel and the gout, which frequently interchange, the digestion almost always suffers, and acid is found in the primee vise; also because cattle often have biliary calculi in the spring, which disappear after they have fed for a time on green fodder. Calculi form themselves in those secreted fluids which contain many ingredients, and which have an inclination to assume a solid form, especially in such as are collected in particular receptacles (the gall bladder and. urinary bladder); and they have even been found in the salivary ducts. They consist of a nucleus and several surrounding coats, similar or various in their nature. Their component parts vary according to the fluid in which they have been formed. They obstruct the passages, and prevent the discharge of the secreted fluid; they irritate the vessels in which they are contained, and thereby cause convulsions, pains, inflammations and suppurations; they also affect, indirectly, other organs, e. g. the stomach, producing sickness and vomiting; the stones in the bladder occasion itching in the glands of the genitals, pains in the loins, testicles, &c. The most common calculi are, A. biliary calculi, often found in great numbers in the bile, sometimes in the liver, from the size of a pea to that of a hazelnut. They are dark, brown, black, and usually polished on several parts of the surface, and generally occasion disease only when they move, and are very jagged. But in such cases violent pains exist, which extend from the right side to the centre of the body. They also sometimes cause periodical and obstinate jairn dice, The convulsions and pains which they occasion frequently require the application of particular medicines io relieve the immediate suffering, besides those directed against the disease itself: the patient is often relieved from them by vomiting or by stool. B. Urinary calculi are sometimes a kind of coarse sand, called gravel, which sinks immediately to the bottom of the vessel in which the urine is left. Sometimes they are real stones, of the size of a pea, of a walnut, or even of the fist. They are found either about the kidneys, and then cause pains, inflammations, and suppuration, or in the pelvis of the kidneys. .In this case, from time to time, single stones pass into the bladder, with violent pains extending from the region of the kidneys downward or backward, and are carried off with the urine; or they originate in the bladder itself, where they often acquire a very considerable size. They cause pains in the region of the bladder and in the perinseum, and great suffering during the discharges of the urine. It often happens that this can be discharged only in certain positions, and drop by drop, with great pain; is slimy, smells offensively, and is mixed with blood and gravel. The examination by the catheter affords the most certain information respecting the existence of calculi, if, as sometimes happens, the stone does not lie enclosed (encysted) in a certain part of the bladder. To destroy urinary stones, internal means have been recommended ; but they are little to be depended on. If the stone in the bladder increases so much that it prevents entirely the discharge of the urine, it is necessary to remove it by the knife (lithotomy), or by breaking it to pieces in the bladder (lithotrity). The operation of lithotomy may be performed in four different ways: 1. By the apparatus minor, an operation described by Celsus, and very simple, requiring few instruments; whence the name. The operator introduces his middle ringer and fore finger up the anus, and endeavors to bring the stone towards the neck of the bladder. He then cuts on the left side of the peringeum, directly on the stone. % In the high operation, the bladder is opened on the opposite side, over the pubes. 3. When the apparatus major is applied, the urethra is widened so much, that a forceps can be introduced, and the stone extracted. The name of apparatus major is used on account of the number of instruments required. 4, The %terai operation is generally considered as the safest and most effectual, and is the most common. Its object is todivide that part of the urethra which suffered extremely in the application of the apparatus major, from the means used to distend it; and as the lower . side of the urethra cannot be divided far enough, without the rectum being wounded, the cut is directed sideways. This is the reason of the name. Lately, the operation of cutting the bladder through the rectum has been introduced.