Volume 1

A dictionary of practical surgery / [Samuel Cooper].

  • Samuel Cooper
Date:
1825
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical surgery / [Samuel Cooper]. Source: Wellcome Collection.

    24/1282 (page 12)
    by others unequivocally of this nature. In a case recorded by Brunner, and in another by Vater, the absence of certain symptoms in the first, and the magnitude of the calculus in the se- cond, created doubts whether the concretions were not more likely to be of the intestinal kind, than of the hepatic. At length, the bodies hav- ing been opened, the presence of other similar calculi in the gall-bladders affurded an adequate criterion. Morgagni lays down a fourth criterion, de- duced from the number of the calculi voided ; which, if very numerous, are to be considered as biliary. Rubini points out, however, the fallacy of this test; both hepatic and gastric concre- tions being sometimes single, sometimes in va- rious numbers even up to a thousand; and he refers to a case where a very large number of concretions of the gastric description were voided, however, may be considered as generally valid ; for, the number of intestinal concretions is rarely more than two, though sometimes very consider- able. (JZ. Thomson. See Med. Chir. Journ. Vol. 4, p. 189.) I shall now follow Rubini, and notice those cha- racters of alvine concretions, which he calls inter- nal, and are deduced from their quality and com- position, beginning with the criterion furnished by the size of the extraneous substance voided. As the biliary ducts are narrow, it is obvious that, if the calculus be above a certain size, it cannot have passed in this state suddenly through those narrow tubes, and consequently must be either of the gastric description, or mixed, having quitted the:hepatic system while small, and afterwards increased within the alimentary canal. Unques- tionably, as Rubini admits, this criterion has con- siderable weight, especially when the discharge of the calculus has not been preceded by pain, or other symptoms indicating such violent distention, as the above ducts must have suffered from the passage of the foreign body. These are certainly capable of being dilated in a remarkable degree, as some facts, already noticed in this article, suf- ficiently prove; but, such dilatation can never happen without pain, irritation, anda serious train of sympathetic effects. Rubini remarks, this cri- terion will only apply to large, and not to dimi- nutive concretions. A biliary calculus, of prodi- gious size, was found by Mr. Brayne, of Banbury, to thave passed by ulceration directly from the cavity of the gall-bladder, into that of the duo- denum, whence it made its way through the rest of the rbowels, and was voided from the anus. (See Med. Chir. Trans. Vol. 12. ) A second criterion is the colour of the calcu- Jus; a test, admitted by Moreau, who asserts, that biliary calculi are yellow, or green, and in- testinal ones grayish brown, or black. But, says Rubini, one need only look at various specimens of alvine concretions, and read the statements of authors, who have seen a great many of. them, particularly Morgagni and Soemmering, to com- prehend, that any criterion deduced from their colour, is most fallacious, every species of them presenting great variety in this particular. And it is to be remembered, that the bile and the intestinal fluids, whence these concretions are formed, differ in colour ‘in different individuals, aczording to a varicty of circumstances, in health and disease. One species of hepatic ,caleulus has a white colour, but is sometimes yellow or greenish, Another is of a round or polygonal shape, and often of a gray colour externally, and brown within, A third is of a deep brown, or green colour. (See Ure’s Dict. of Chemistry, art. Gall-stones.) ‘The smaller intestinal concre- tions, examined by Dr, 'T. Thomson, destitute of coating, resembled bad yellow ochre; the larger were encrusted with an earthy matter, of a coffee colour, and purple, or sometimes white. (See Monro on the Human Gullet, &c. and Med. Chir. Journ. Vol. 4, p. 188.) Third criterion. The presence or absence of a nucleus will enable one to judge, whether a calculus be gastric, orhepatic. “A biliary con- cretion has no nucleus, properly so called; that is to say, it has no foreign body in its centre. When a transverse section is made of such a calculus, one either finds a cavity in its middle, or else nothing by which this part of its if a nucleus, different from the other part of the concretion, be apparent there, it consists merely of bile, either grumous, differently coloured, or more or less fluid, than the rest of the calculus, © but which is nevertheless invariably bile. On the contrary, every gastric concretion has, as it were, an extraneous nucleus, as Foureroy and Vauquelin have explained in their essay upon the intestinal caleuli met with in animals. Ruysch in the Phil. Trans. gives an account of some alvine concretions, which were formed round grains of seed, Birch records an example of a crystallized calculus, formed round a leaden bul- let. Haller met with a calculus, in the centre of which was an iron nail. Concretions, formed upon fruit stones, are recorded by Clarke, White, and Hey, and also in the Edinb. Med. Essays. Instances, in which the nucleus was a small por- tion of bone, are related in the latter work, and also by Hooke and Coe. Homberg and others describe alvine concretions, formed round indu- rated excrementitious matter: and many similar cases are specified by Vallisnieri, Van Swieten, and others. In the hepatico-gastric calculus. the biliary concretions serve as a nucleus for the gastric. According to Dr. T. ‘Thomson, the nu- cleus is commonly a cherry-stone, a small piece of bone, or a biliary calculus. (See Med. Chir. Journ. Vol. 4, p. 188.) A fourth criterion is deduced from a certain unctuosity, which belongs to biliary caleuli, but not to those of the gastric class. ‘This character is more palpable, when the calculus has been re- cently voided, or when it is handled with warm fingers. The unctuosity is still more evident, when the concretion is cut, or sawn, as then the knife, saw, or fingers, become smeared with sapo- naceous particles, which adhere to them. In order to denote an hepatic calculus, however, the unctuosity must pervade its whole substance, and not merely appear towards its outside; for, a gastric, earthy, saline concretion may by accident become coated, as it passes through the bowels, with a stratum of bile, or saponaceous matter. When the unctuosity is deficient externally, or in — the outer laminze of a calculus, but is found in its interior, it is a clear indication of the hepatico- — gastric formation of the concretion. + Fifth criterion. The specific gravity of a.