Of the STONE.
STONY Concretions are a Disease, incident to several Parts of the Body; but I shall treat only of those formed in the Kidneys and Bladder: Hitherto there has never been given any satisfactory Account of the Causes of this concreting Disposition in the Fluids; and tho' there may be some Propriety in considering the Sand of Urine, in the same light as the Tartar of Wine, from their Similitude in several Experiments, yet we cannot infer from thence, what does immediately produce it; at least, it is not with any Certainty to be imputed to a particular Diet or Climate, which however are the Causes commonly assigned since we see that in all Countries, and amongst all Ranks of People, as much among the Sober, as the Luxurious, the Stone is a frequent Distemper; and though the great Numbers cut at the Hospitals of Paris, where the Water of the Sein is so remarkable for its quantity of Stone, seems to favour the Opinion of its being generated by particular Fluids received into the Blood; yet I believe, upon enquiry, this famous Instance will not appear conclusive; since Most of those Patients come from the Provinces, or distant Villages, where that Water is not drunk; and as to the Inhabitants of Paris itself, by what I was able to learn of the Surgeons there, the number of those afflicted with the Stone amongst them, is pretty nearly in the same proportion as in London: From which Considerations, and the circumstance of so many more Children having the Stone than Men, one would be inclined to think, the Disposition is much oftener born with us, than acquired by any external means. I once saw a Stone, in the Kidney of a Foetus, at the Term of seven Months growth, which, had it lived, was two Months before it would have been born.
It is certain the Urine generally abounds with matter proper to compose a Stone, and perhaps if it could grow cold in the Bladder, it would always deposite the Matter there, as it does on the Sides of the Chamber-pot, tho' the Coats of the Bladder being covered with a Mucilage, makes them more unfit than the Sides of the Pot, to attract the stony Particles; but we see, when once a hard Body is insinuated into the Bladder, it seldom fails to become the Nucleus of a Stone, whether it be a large Piece of Gravel, a Needle, a Bullet, or any other firm, extraneous Substance, even grumous Blood.
From the monstrous Increase of some Stones in a small time, and the Cessation of Growth, for many Years, of others, we may be persuaded that the Constitution varies exceedingly at different times, with regard to these stony Separations; and from the Appearances of most Stones, when artfully sawed through, we may gather, that this Variation of Constitution does not shew itself only in the Quantity of Gravel added to the Stone, but the Quality of it also; so that a red uniform Stone of an Inch diameter, may perhaps at half that Size, have been a smooth white one; at a quarter, a brown Mulberry one; and so on, at different times, altering in its Species. Hence, (from the Apposition of differently coloured Gravel,) arises for the most part, the laminated Appearance of a Stone; tho' some times the Laminæ are very nearly of the same Colour and Composition; and in this Case, their Formation seems to be owing to the want of Accretion in the Stone for a certain Time, during which, its Surface, by rubbing against the Coats of the Bladder, and its Attrition from the Stream of Urine, becomes smooth and compact; so that when more fresh loose Gravel adheres to it, its different Density in that Part, will necessarily make the Streaks we see in a of the Stone, which are only the external Surfaces of each Lamina.
That the ceasing to grow, gives them this laminated Form, and not any particular Disposition in Sand to shoot into such a Shape, is probable from the Examination of some other Stones, in which a great Quantity of Gravel is first collected without Any Nucleus, into a spongy uniform Mass, and after that, is covered with several Laminæ.
It is no wonder that Stones so generally form in the Kidneys, since the Disposition of the Urine will naturally shew itself as soon as it is separated into the Pelvis, that is, the stony Particles having as strong an Endeavour to unite with one another in the Kidneys as the Bladder, will consequently, from meeting first there, generally produce Gravel and Stone in that Part; nay, I have found by opening the Kidneys of calculous People, that Stone is formed even earlier than I have here suggested, for in them the Tubuli Belliniani were full of Gravel.
Small Stones and Gravel, are frequently voided without Pain; but sometimes they collect and become very large in the Kidneys; in which case, a Fit of the Stone in that Part, is the Cure, from the Inflammation and Pain occasioning convulsive Twitches, which at last expel them: But in this Disease, the Patient is very much relieved by several kinds of Remedies, such as the mucilaginous, the saponaceous, &c. some of which lubricate, and others both lubricate and stimulate. The Sand in passing through the Ureters, is very much forwarded by the Force of the Urine, which is so considerable, that I have seen a Stone that was obstructed in the Ureter in its first Formation, perforated quite through its whole Length, and form a large Channel for the Stream of Urine. The Ureters being very narrow, as they run over the Psoas Muscle, and also at their Entrance into the Bladder, make the Movement of the Stone very painful and difficult in those Parts; but there is seldom so much trouble after the first Fit; for when once they have been dilated, they generally continue so: I have often seen them as big as a Man's Finger, but they have been found much larger.
When once a Stone has acquired a moderate Size in the Bladder, it usually occasions the following Complaints: Frequent Inclination to make Water, excessive Pain in voiding it Drop by Drop, and sometimes a sudden Stoppage of it if discharged in a Stream after urining, great Torture in the Glans Penis, which lasts, one, two, or three Minutes; and in most Constitutions, the violent Straining makes the Rectum contract, and expel its Excrements, or if it be empty, occasions a Tenesmus, which is sometimes accompanied with a Prolapsus Ani: The Urine is often tinctured with Blood from a Rupture of the Vessels, and sometimes pure Blood itself is discharged; sometimes the Urine is very clear, but frequently there are great Quantities of slimy Sediment deposited at the Bottom of it, which is no other than a preternatural Separation of the Mucilage of the Bladder, but has been often mistaken for Pus; whence has arisen an Opinion, that Ulcers of the Bladder are common, tho' in fact the Distemper is very rare.
These are the Symptoms of the Stone in the Bladder; yet by no means are they infallible; since a Stone in the Ureter or Kidneys; or an Inflammation of the Bladder from any other Cause, will sometimes produce the same Effects: but if the Patient cannot urine, except in a certain Posture, 'tis almost a sure Sign the Orifice is obstructed by a Stone; if he finds Ease by pressing against the Perinæum with his Fingers or sitting with that Part upon a hard Body, there is little Doubt to be made that the Ease is procured by taking off the weight of the Stone; or lastly, if with most of these Complaints, he thinks he can feel it roll in his Bladder, it is hardly possible to be mistaken; however, the only sure judgment to be formed, is from searching.
That we should not readily distinguish the Complaints of the Stone, from many other Affections of the Bladder, is not very surprising, when we reflect that a Fit of the Stone is nothing but an Inflammation of its Coats, which tho' it be excited by the Stone, requires a Disposition in the Blood to produce it; for if the Complaints in a Fit, were owing to the immediate Irritation of the Bladder, it should follow that the Stone being always the same, the Fit would be continual; but besides that all Patients have considerable Intervals of Ease (often of many Months) except in those Cases where the Stone is either very large or pointed, there are Instances of some few happy Constitutions, where they have no Pain, even after having, for a certain time, suffered very much.
To prevent the Violence, and frequent Returns of the Fits of the Stone, Bleeding and gentle Purging with Manna, are beneficial; abstaining also from Malt-liquors, and Excess of Eating and Drinking, is very serviceable; but, the Milk-Diet and Honey are the greatest Preventives, not only of Inflammation, but perhaps sometimes too, of the farther Accretion of the Stone.
From considering the Disorders of the Stone in this light, and the frequent Intervals of Ease which happen without the Assistance of Medicine, we cannot wonder that so many Patients have believed the Stone dissolved, When they have been under any particular Regimen; and that in all Ages there have been many People deceived for a length of Time, by a supposed Dissolvent, tho' we have not hitherto known any safe one, till lately that Lime and Soap have been discovered to have sometimes that Effect.