A dictionary of practical surgery : comprehending all the most interesting improvements ... an account of the instruments ... the etymology and signification of the principal terms ... / by Samuel Cooper ; with numerous notes and additions ... together with a supplementary index ... by David Meredith Reese.

  • Cooper, Samuel, 1780-1848.
Date:
1844
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Licence: Public Domain Mark

Credit: A dictionary of practical surgery : comprehending all the most interesting improvements ... an account of the instruments ... the etymology and signification of the principal terms ... / by Samuel Cooper ; with numerous notes and additions ... together with a supplementary index ... by David Meredith Reese. Source: Wellcome Collection.

Provider: This material has been provided by the Woodruff Health Sciences Center Library at Emory University, through the Medical Heritage Library. The original may be consulted at the Woodruff Health Sciences Center Library, Emory University.

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    testinal concretions is rarely more than two, though sometimes very considerable.—'(T. Thomson. See Med. Chir. Journ vol. 4, p. 189.) I shall now follow Rubini, and notice those charac- ters of alvine concretions, which he calls internal, and are deduced from their quality and composition, begin- ning with the criterion furnished by the size of the ex- traneous substance voided. As tne biliary ducts are narcow, it is obvious, that if the calculus be above a certain size, it cannot have passed in this state sud- denly through those narrow tubes, and .consequently must be either of the gastric description or mixed, having quitted the- hepatic system while small, and afterward increased within the alimentary canal. Un- questionably, as Rubini admits, this criterion has con- siderable weight, especially when the discharge of the calculus has not been preceded by pain, orother symp- toms 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, sufficiently prove; but such dilatation can never happen, without pam, irritation, and a serious train of sympathetic effects. Rubini re- marks, this criterion will only apply to large, and not to diminutive concretions. A biliary calculus, of pro- digious size, was found by Mr. Brayne, of Banbury, to have passed by ulceration, directly from the cavity or the gall-bladder into that of the duodenum, whence it made its way through the rest of the bowels, and was voided from the anus.—(See Med. Chit. Trans, vol. 12.) A second criterion is the colour of the calculus; a test admitted by Moreau, who asserts, that biliary calculi are yellow or green, and intestinal ones gray- ish 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 Soemmer- ing, to comprehend, 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 arc formed, differ in colour in different individuals, according to a variety of cir- cumstances, in health and disease. One species of hepatic ealculus has a white colour, but is sometimes yellow or greenish. Another is of a round or poly- gonal shape, and often of a gray colour externally, and brown within. A third is of a deep brown or green colour—(See Ure's Diet, of Chemistry, art. Rail- stones.) TJie smaller intestinal concretions 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 some- times white—(See Monro on the Human Gullet, &c, and Med. Chir. Journ. vol. 4, p. 188.) Third criterion. The presence or absence of a nu- cleus will enable one to judge whether a calculus be gastric or hepatic. A biliary concretion 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 finds either a cavity in its mid- dle, or else nothing by which this part of its, substance can be distinguished from the rest; or if a nucleus dif- ferent from the other part of the concretion be apparent there, it consists merely of bile, either grumous, dif- ferently 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 Fourcroy and Vauquelin have explained in their essay upon the intestinal calculi 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 bullet. 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 m the Edinb. Med. Essays. Instances in which the nucleus was a small portion 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; ana many similar cases are specified by Vallisnieri, Van Swieten, and others. £thfhepatico-gastric calculus the biliary concretions £rve as a nucleus for the gastr.c. According to, Dr. T Thomson, the nucleus is commonly a cherry-stone, a small piece of bone, or a biliary calculus.-(See Med Chir. Journ. voK 4, p. 188.) . „„„.„ A fourth criterion is deduced from a certain unctu- osity which belongs to biliary calculi, but not to those of the gastric class. This character is more pa pable when the calculus has been recently voided, or when it is handled with warm fingers. The unctuosity is still more evident when the concretion is cut or sawn, as tnen the knife, saw, or fingers become smeared with sapona- ceous particles, which adhere to them. In order to denote an hepatic calculus, however, the unctuosity must pervade its whole substance, and not merely ap- pear towards its outside; for a gastric, tearthy, saline concretion may by accident become coated, as it passes through the bowels, with a stratum of bile or sapona- ceous matter. When the unctuosity is deficient exter- nally, or in the outer.laminoe of a calculus, but is found in its interior, it is a clear indication of the hepato- gastric formation of the concretion. Fifth criterion. The specific gravity of a calculus, the property which it has of floating or sinking in. wa- ter, has been long considered as a test of its species. The hepatic calculus is generally specifically lighter than water, as most oily substances are.: on the con- trary, gastric calculi are specifically heavier than wa- ter, like all earthy saline matter, and of course sink m that fluid. This criterion was often employed by Re- verhorst, Fernelius, and others, for distinguishing va- rious 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. Jpurn. vol. 4, p. 179.) As Rubini observes, this test will not answer for hepatico-gastric calculi, which are subject to great anomalies.—(Pensieri, &c. p. 22.) Neverthe- less, the most correct modern examinations prove, that gastric concretions have a specific gravity varying from 1.376 to 1.540 (Dr. T. Thomson in Monro's Morb. Anat. &c.),and consequently their general character is to be heavier than biliary calculi. y ■ ■ • A sixth criterion is that proposed by Vicq d'Azyr in the Mem.de 1'Acad. Royale de Med., and deduced from the figure pf the crystallization. According to this writer, intestinal concretions, crystallize in concentric laminifi, shaped-like a cock's comb, while the crystalli- zations 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 dis- tinction here proposed, that the concretions 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 indis- pensable. Heiice 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 calculus 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 exter- nally, and brown within, is described as consisting of concentric layers of inspissated bile, usually with a nucleus of the white crystalline matter in the centre. Lastly, the hepatic 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 Diet. 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 nature discharged from the human body; because, as the bile varies in different animals, so must the formative prin- ciples of the calculous crystallizations. It is farther remarked by Rubini that the substance termed adipo- cire, which' is the basis of biliary concretions, was not found by Poulletier in hepatic calculi taken from horned cattle. A seventh criterion is founded upon the inflammabi- lity of an alvine calculus. A.biliary concretion being commonly made up altogether of unctuous matter, liquefies when subjected to heat, smokes', emits a flame, and burns. When this experiment is made in close vessels, the products are hydrogen, carbonic-acid gas, oil, and ammonia: some carbon and earth remaining