Licence: Public Domain Mark
Credit: A dictionary of practical surgery / [Samuel Cooper]. Source: Wellcome Collection.
20/1282 (page 8)
Licence: Public Domain Mark
Credit: A dictionary of practical surgery / [Samuel Cooper]. Source: Wellcome Collection.
![adverts to cases, in which the concretions evacu- ated were innumerable. (Pathol. lib. 6. cap. 9.) If we take a view of alvine concretions generally, and include all their different kinds, we shall find that they are of various sizes. Most of them are uot larger than a pea or nut; but others are as large as an orange, and weigh four pounds. (See Monro’s Mor bid Anat. of the Human Gullet, &c. and Medico-Chir. Journ. vol. 4. p. 188.) Morgagni saw one, which equalled in size a mo- derate finger, and Gooch, Guettard, Heuermann, Maréschal, (Jécm. de P Acad. Royale de Chir. t. 3. p. 5.) aud others, have seen concretions of this nature, which were too bulky to pass out of the rectum without surgical aid. In certain ex- amples, recorded by Heuermann and Maréschal, the passage of the concretion outward lacerated the sphincter ani. Horstius speaks of one con- cretion, which was as large as an apple, (Epist. l, 2. sect. 2. Opp. 2. p. 237.) and Marcellus Donatus, Schwind, (Schmucker’s Verm. Schrif- ten, 2 b. p. 129.) Hooke, Venette, and Hecquet, give the particulars of other cxamples, in which the concretions discharged were as large as a hen’s egg. Mr. C. White extracted two from the rectum which were nearly as big as the fist; (Cases in Surgery, p. 18.) and ina boy, who had died in an emaciated state, after continued pain in the abdomen, attended with frequent attacks of ileus, Mr. Hey found in the transverse arch of the colon so large a concretion, that it could not pass any further along the bowel, and appeared to have been the sole cause of the boy’s death. (Practical Obs. in Surgery, p- 509. ed. 2.) An analogous case is also reported by White(p. 28.) It is stated, in the Mém. del Acad. de Chir. that Duhamel sawaconcretionthat had been discharged, which was two inches and a half in length, one inch and a half in diameter, three inches and a half in circumference, and the weight of which was three drams and a half. But, judging by their weight, how much larger those must have been, which were seen by Scroekius and Lettsom, and weighed ten drams3; that reported by Delceus, which weighed two ounces; that recorded by Orteschi, which, besides weighing two ounces, two drams, and a half, is said to have been eight inches in Dircuimferanos, and to have been baken out by force; that recorded by Schaarschmidt, which weighed four ounces; and lastly, the speci- men cited by Plouquet, (Literatura Med. Dig. vol. 1. p. 171.) the weight of which is alleged to have been half a pound. (Sammi. Med. Wahr- nehm, 9b. p. 231.) It is observed by Rubini, that, although examples of alvine concretions being discharg ged by vomiting are not so frequent as the foregoing cases, yet they are tolerably numerous. Many of them have been collected by Schenck, and others are collected by Breyn (Phil. Trans. No. 479.)3; by Orteschi in his Journal; by Moreali, (De l? Uscita- di una Pietra, per la Via del Esophago, Modena, 1781.) ; by Borsieri; and by a long list of other writers, whose names and publications are specified by Plouquet. (Lit. Med. Dig. art. Calculus, Vomitus, &c-) With this bigs of substances, says Rubini, m may also be arranged those concre- tions, which are found upon dissection, either in the intestines or stomach, whence, probably, in time they might have been expelled. Facts of this description are recorded by Portal, Vicq dAzyr, Jacquinelle, Chandron, ke. The cases, recited by White and Hey, in which the colon was completely obstructed, I have already men- tioned; and to these may be added the instance quoted by Rubini, in which Meckel found the jejunum entirely blocked up by a similar substance. (See Pensicri sulla varia origine e natura de corpt calcolosi, che vengono talvolta espulsi dat tubo gastrico, Memoria, p- 5 and 6. Ato. Werenes 1808.) Rubini observes, that, with respect to the ori- gin of alvine concretions, whether discharged from the alimentary canal upwards or downwards, some of them appear to be formed. in that canal itself, while others pass into it from other situa- tions; and they al] admit of being distinguished according to the place of their origin and forma- tion into three kinds; 1. hepatic, or biliary ; 2. gastric, or intestinal ; and 3- (what this author terms) mixed, or hepatico g castric. Hepatic alvine concretions, as the name implies, are derived from some point of the hepatic system; the gastric, or intestinal, are formed within the alimentary canal; and the métxed commence in the hepatic organs, but afterwards get into the bowels, where they acquire an increased size. On the subject of hepatic concretions, or biliary calculi, or gall-stones (as they are usually named), there is no point of this system, where they do not occasionally form. Riedlin found them in the surface of the liver. Sorbait met with a biliary calculus, as large as a goose’s egy, adhering to - the peritoneal covering of the liver, and a similar case is recorded by Benivenio. Tallon, Pomme, Saurau, and Heberden .have seen calculi within the substance of the liver; while Blasius, Fallo- pius, Columbus, Ruysch, Henricus ab Heers, and Morgagni, record examples, in which the con- cretions were in the parenchyma of that organ. Plater, Reverhorst, Glisson, Morgagni, and Wal- ther, have seen them in the biliary ducts, as pro- bably were those, which Columbus and Camenicus say they found in the vena portez. Walther and Dietrick found calculi in the ductus hepaticus ; Ruysch and Soemmering in the ductus cysticus ; and Dietrick, Galeazzi, and Richterin the ductus choledocus. Greise], Benivenio, Eller, Morgagni, Dargeat, and D’Hervillay, have seen calculi in- cluded in morbid cysts, attached either to the liver or the gall-bladder.. The place, however, where calculi are found in the greatest number, and with most frequency, is the cavity of the gall-bladder itself. Here. they are sometimes single, their size varying up to a magnitude completely filling that cavity, as Saye, (Journ. de Savans, Sept. 1697.) Halle, and Isenflamm, have. noticed: while sometimes their number amounts to a hundred, or even a thousand, of different sizes. Rubini possesses a gall-bladder, which contains above a hundred small calculi, and formerly I had a similar number, which I found in the body of a female. Van Swieten met with a hundred; Haller, a hundred and forty; Stieber, two fine dred; F. Plater, three hundred; Walther, five hundred ; Mentzki, seven fiindred s Baillie, a thousand; Hunter, eleven hundreds Paré, six- teen hundred ; Stork, two thousand ; and Meckel several thousands, (Handb. der Pathol. Anat. b. 2. p. 460.) All hepatic concretions, however, are not cal- culated to pass from the place of their origin](https://iiif.wellcomecollection.org/image/b33285263_0001_0020.jp2/full/800%2C/0/default.jpg)
