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.

    25/1282 page 13
    calculus, the property, which it has of floating or sinking in water, has been long considered as a test of its species. The hepatic calculus is gene- rally specifically lighter than water, as most oily substances are: on the contrary, gastric calculi are specifically heavier than water, like all earthy saline matter, and of course sink in that fluid. This criterion was often employed by Reverhorst, Fernelius, and others, for distinguishing various concretions. But it is by no means regular, as many biliary calculi swim only a little while and then sink. The specific gravity of that analyzed by Dr. Ure' of Glasgow, was-1-0135. (See Med. Chir. Journ. Vol. IV. p.179.) As Rubini observes, this test will not answer for hepatico-gastric cal- culi, which are subject. to great anomalies. (Pen- siert, §c. p. 22:); ‘Nevertheless, the most correct modern examinations prove, that gastric concre- tions have a specific gravity, varying from 1°376 to 1540, (Dr. T. Thomson in Monro’s Morb. Anat. &c.) and, consequently, their general cha- racter is to be heavier, than biliary calculi. A sixth criterion is that proposed by Vicq @Azyr, in the Mém. del Acad. Royale de Med. and deduced from the figure of the crystallization: According to this writer, intestinal concretions crystallize in concentric laminz, shaped like a cock’s comb, while the crystallizations of biliary calculi are radiated and needle-shaped. Although this criterion is ingeniously founded upon the known laws, by which every crystallized substance assumes a peculiar and determinate shape, yet it may be generally observed, with respect to the mark of distiiction here proposed, ‘that the con- eretions, of which we are now: speaking, are usually too compound, and too much disturbed in their crystallization, to exhibit a regularity, for which simplicity. and quietude are indispensable. Hence, many of these concretions do not present the slightest vestige of crystallization, while others scarcely show a trace of it, in the midst of a large misshapen mass. The white coloured hepatic cal- culus, when broken, is said to present crystalline plates, or stria, brilliant and white like mica. The round, or polygonal one, which is often of a gray colour externally, and brown within, is de- scribed as consisting of concentric layers of in- spissated bile, usually with a nucleus of the white crystalline matter in the centre. Lastly, the hepatie calculi, of a deep brown, or green colour, when broken, are said to exhibit a number of crystals of the substance resembling spermaceti, mixed with inspissated bile. (See Ure’s Dict. art. Gall-stones.) With respect to the special shape, assigned by Vicq d’Azyr to the two classes of alvine concretions, it may be observed, that his specimens were taken from animals, and that consequently, the inferences made from them are not applicable to substances of an analogous na- _ ture, discharged from the human body ; because, as the bile varies in different animals, so must the formative principles of the calculous crystalliza- tions. It is further remarked by Rubini, that the ‘substance termed adipocire, which is the basis of biliary concretions, was not found by Poul- letier in hepatic calculi taken from horned Cattle, . _.A seventh criterion is founded upon the in- flammability of an alvine calculus. A biliary concretion being commonly made. up altogether Of unctuous matter, liquefies when -subjected to 13 heat, smokes, emits a flame, and burns. When this experiment is made in close vessels, the pro- ducts are hydrogen, carbonic acid gas, oil, and ammonia: some carbon and earth remaining be- hind. An intestinal concretion, on the other hand, decrepitates, or turns black, but generally does not burn. One specimen, examined by Dr. Ure, when heated to. the temperature of 400 F- fused into a black mass, and exhaled a copious white smoke, in the odour of which was recognized that of ambergris, mixed with the smell of burning fat. Exposed ina platina capsule to a‘ dull red heat, it burnt with much flame, and smoke, leay- ing no appreciable residuum. (See Ure’s Dict. of Chemistry, art. Intestinal Concretions.) The eighth criterion depends upon the solubi- lity of calculi.in an oily menstruum. Haller dissolved biliary calculi in oil of turpentine; Dietrick found them soluble in oil of sweet al- monds ; and Gren in oils in general. But, in- testinal calculi are not so readily dissolved by any ‘of these menstrua. The ninth criterion is founded upon the solu- bility of the calculus in alcohol. In biliary cal- cull, this solubility is not always the same; but as this point has been already spoken of, it is un- necessary to dwell upon it; and I shall merely add, that, while hepatic concretions are almost always more or less dissolved by alcohol, those of the gastric kind resist this menstruum. Though the above criteria are interesting, as tending to establish distinctions betwixt the dif- - ferent species of alvine concretions, it merits at- tention, that not one of them, taken separately, is at all certain and pathognomonic. It may hap- pen, says Rubini, that some peculiarity in the biliary secretion, and an irregularity in the ery- stallization and accumulation of the matter, may cause salts and. earths to predominate in hepatic concretions, in which circumstance, their usual oily quality will be defective. On the other hand, in the formation of an intestinal concretion, oily adipose matter may accidentally adhere to it, so as to disguise its wonted character. If uni- formity of characters and physical properties de- pend upon uniformity of elementary constituent principles, it ean hardly happen even in the na- tural healthy state of the secretions, because age, sex, and other particular circumstances of the in- dividual, will always make a difference in the pro- portions of those principles.. How then can iden- tity of results be expected.in a diseased state of the process of secretion ?—Such reflections may explain, how Morgagni, amongst. others, met with many biliary calenli, which were not inflam- mable; with others, which did not give a yellow tinge to water; and with some which floated, or sunk in water, according as they had been re- cently, or long discharged; while Gren found some of these calculi insoluble in-alcohol, &c. (Rubini, p. 24, 25.) Moreali put a piece of the outer part of an al- vine concretion into nitrous acid, when a con- siderable effervescence took place, and the sub- stance afterwards completely dissolved. Now, as this calculus had a nucleus, it must have been of the hepatico-gastric kind, and the experiment was therefore made ‘only with the intestinal part of it. - Should the experiment be often ‘repeated with the same result, says’ Rubini, it would fur- ‘nish another criterion for distinguishing the two
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