A treatise on the formation, constituents, and extraction of the urinary calculus. Being the essay for which the Jacksonian prize for the year 1833 was awarded by the Royal College of Surgeons in London / by John Green Crosse.

Cross, John, 1790-1850.

Date:: 1841

Credit: A treatise on the formation, constituents, and extraction of the urinary calculus. Being the essay for which the Jacksonian prize for the year 1833 was awarded by the Royal College of Surgeons in London / by John Green Crosse. Source: Wellcome Collection.

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$after finding that they may strike each other so hard as to be broken up into small fragments. Some angular urinary calculi, with flat surfaces, resembling biliary calculi, when in considerable number in the gall-bladder, are I conceive formed by fracture; such as are represented in fig. 4 of plate ii furnish an example; thirty were removed by cystotomy from one patient; they are of different sizes, but mostly of an angular shape, with flat smooth surfaces, very light in colour, and composed of lithic acid and oxalate of lime. When a calculus is once formed in the urinary bladder, and has attained too great a size to pass away by the urethra, it is correct to state, that it will generally go on increasing in size, so long as the patient lives to be tortured by its presence. It cannot however be denied, that if the patient maintain good health, the urine be kept in a normal state, and the coats of the bladder or of other parts of the urinary passages do not take on diseased action, the stone may remain for a time stationary as to size ;2 this is a point so doubtful and difficult, that many examples must he collected before it can be settled. I have met with only one, in the case of a patient who, twenty years before his death, was assured by his surgeon, after sounding, that he had a stone; he refused the operation, and at the end of that number of years died, and the stone found in his bladder weighed only six drachms and one scruple, and was composed of almost pure lithic acid. If any calculi can remain stationary as to size in the human bladder, I should expect those of lithic acid or oxalate of lime to do so ; these being the calculi of slowest growth, and accompanied by the least degree of disease in the lining mem- brane of the bladder. In general, calculi when once formed go on increasing; and the estimate I venture to make, from a careful comparison, in a vast many instances, between the duration of the symptoms and the size of the stone removed by cys- totomy, is that a concretion of lithic acid or oxalate of lime will, in an adult, 2 Delpech gives the doctrine that a calculus, having attained to a certain size, may cease to increase, and the bladder become accustomed to its presence, so that very little pain is suffered. “ L’experience prouve que dans certains cas, vingt-ans n’ont pas suffit pour porter la volume d’une pierre au point de rendre son extraction indispensable.” Precis des Maladies Reputees Chirurgicales, tom. 2,p. 227. C 2$