Volume 4

The cyclopaedia of anatomy and physiology / edited by Robert B. Todd.

Date:
1836-1859
Catalogue details

Licence: Public Domain Mark

Credit: The cyclopaedia of anatomy and physiology / edited by Robert B. Todd. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

    92/702 (page 76)
    almost constantly occurs in calculi, and some- times forms the nucleus of a mass. Howship has figured a remarkable specimen, voided from the urethra of a negress, in which the nucleus consisted of mucus, associated with a very little phosphate of lime, — the cortex of more solid phosphates. Clots of blood occa- sionally ibrm the central part of calculi; a fact noticed first by Frere Come. Thirdly: foreign bodies, introduced from v/ithout, not very unfrequently constitute the nuclei of urinary calculi. In the great majority of cases these bodies are directly pushed into the bladder ; but in some well-authenticated cases have reached that viscus after having been swallowed or otherwise introduced. Among bodies acting as nuclei have been met pins (Univ. Coll. Mus.), needles, tooth-picks, ear- picks, pieces of wood, stems of plants, ears of corn, grains of corn, stones of various fruits, tubes of various kinds, glass or earthen, &c., pieces of bougies and catheters, balls and other metallic bodies, a globule of mercury,* pebbles, &c. When the bodies thus introduced are sharp, as pins, they sometimes protrude beyond the calculous matter, and (a fact surgically im- portant), are fixed in the surroundmg tissues. Instead of a nucleus the centre of a calculus may present one or more cavities of variable size and shape, almost invariably lined with a black pulverulent or laminar matter, and sometimes containing powdery substance; in other instances, there is neither surrounding nor contained matter of this kind. It has been supposed that in all these cases an origi- nal vegetable or animal nucleus had been gradually removed by a process of decom- position and subsequent filtration through chinks in the cortex. The prominent physical characters of the cortices of calculi divide them into two na- tural classes; the (a) granular or irregular, and the (Ji) laminated, (a) Of granular calculi the best example is supplied by oxalate of lime, but the appear- ance of these masses is not always identical. Sometimes the mass looks homogeneous and non-granular, manifestly IVom the close aggre- gation of the original granules. In the more ordinary cases the granules remain d stinct, whence the well-known tuberculated or mul- berry-like aspect. Uric acid calculi, rendered impure by association of certain saline matters, assume the granular form ; the phosphates are sometimes granular; and the pulverulent cha- racter of the fusible calculus allies it to this species. (b) In laminated calculi the cortex is, as the * See Malago, in Filiatre Sibezio, 1845; or Si- mon's Chemistry, by Day, vol. ii. p. 440. In the University College Collection is a triple phosphate calculus, having the tibia of a foetus for its nucleus. The pregnancy had been Fallopian, and ulceration having occuri-ed between the adherent tube and the bladder, the tibia (with probably other portions of the skeleton subsequently otherwise disposed of,) made its way into the latter organ, and became en- crusted abundantly with phosphates. The calcxxlus, presented to the College by Mr. Listen, was given to him by Dr. D. R. Lietch. word implies, coniposed of successive layers. Although each layer may and generally does differ in thickness from others, its own thick- ness at its different parts may be said to be commonly pretty uniform ; nevertheless to this there are exceptions, and it is manifest that whenever the cause of accretion is in greater activity towards one aspect of a calculus than another, there the lamina in course of deposi- tion must be thicker than elsewhere. Now in conformity with a general principle already laid down, we should expect the phosphates, which are formed in consequence of local irritation in particular places, to furnish the most fi'e- quent instances of irregular thickness ; and such is in truth the fact, though, as is proved by the annexed cut {Jig. 75), not always so. Fig. 75. Oxalate of lime nucleus; the cortex (circular and conoid parts) impure uric acid. (U. C. Museum; patient of 3Ir. Quain.) The spherical part was probably seated in a succulus. The mode of union of the laminae differs ; it may be so intiniate that the line of separation is lost at certain points of the apposed sur- faces ; in other cases the union is imperfect and loose, and interspaces of some width are left between those siu-faces. The section of a laminated calculus is some- times marked by lines radiating from the centre to the periphery, cutting the laminae into seg- ments of unequal size. This is obvious in certain cystin calculi, in some of uric acid, and in many of the mulberry species. The tint of the different strata of a calculus, composed essentially of one substance, is not always the same throughout ; nor are strata, the same in composition and separated by ma- terials of other kinds, generally of the same hue. These varieties must depend upon irregular admixture of impurities. Calcidi composed, at least essentially, of a Fig. 76. Alternating calculus of uric acid and [?] triple phos- phate. (University College Museum.)