Clinical lecture on the early history of calculous disease : and the treatment best adapted for its prevention : delivered in University College Hospital, in May, 1871 / by Sir Henry Thompson.

  • Thompson, Henry, Sir, bart., 1820-1904.
Date:
1872
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Credit: Clinical lecture on the early history of calculous disease : and the treatment best adapted for its prevention : delivered in University College Hospital, in May, 1871 / by Sir Henry Thompson. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    CLINICAL LECTURE ON THE EARLY HISTORY OL CALCULOUS DISEASE, AND THE TREATMENT BEST ADAPTED EOR ITS PREVENTION, Delivered in University College Hospital, in May, 1871, By SIB HENBY THOMPSON, F.B.C.S., &c. &c. From “THE LANCET,” of January 13th, 1872. Gentlemen,—We have recently studied together and discussed very fully the various operations which are practised for the removal of stone from the bladder, and you have had the opportunity of seeing them performed many times, not less than eleven cases having passed through my ward in a few weeks, each one with a successful result. But, satisfactory as all this is, it suggests to my mind very strongly that there remains an important question for us to consider; as important, indeed, as any of the preceding, and one which must naturally arise in all thinking minds. It is this : Is there not a period anterior to the stage of the malady already examined -—a time at which we might prevent the formation of stone in the bladder, and so get rid of the necessity for removing it ? Admirable as the results of operative means have been—perfect (one may almost say) as they have become, at all events so far as regards the crushing operation—great as is the triumph which surgery lias achieved in removing stone from the bladder—I take it there are very few men indeed who would desire, if they could help it, to exhibit that triumph in their own persons ; all would be infinite^ better pleased if the formation of stone were prevented, rather than removed, however cleverly you may perform the opera- tion. This, then, leads me to the consideration of an important question,—Can we do anything to prevent the formation of stone in the urinary passages ? It is, in fact, the early stage of this malady that will be the subject of our lecture to-day. I commence by saying that I think a great deal may be done. But at the outset of the inquiry we naturally ask, What is the kind of stone (for there are several kinds) the formation of which we may hope to do most in preventing ? All calculi are of local or of constitutional oiigin. By “local” I mean formed by disease in the bladder, and not depending upon any constitutional conditions ; by “ constitutional” I mean formed by some vice in the system. Now, the large majority of stones are of constitutional, and not of local origin. When they are local you know that you cannot prevent their formation except by mechanical moans. Calculous matter, the elements of which are produced in the bladder itself, may be washed out, or may bo broken and then washed out. But when stones are of constitutional origin—and those arc what we arc going to refer to entirely to-day—the elements are separated from the blood, and no mechanical moans of prevention can be thought of for an instant. Now, from observation wo know that nineteen out of twenty of such stones have uric acid for their basis, the remaining one in twenty being oxalate of lime;* and, less commonly still, there arc phospliatio stones, which are of constitutional origin also. Therefore, practically, to all intents and purposes the problem before us is how to prevent the formation of uric-acid calculus. Let us examine the early history of a case of persisting uric-acid deposit. First of all, lot me say, going back to the root of the matter, that it is generally more or less hereditary. As a single illustration of this, wo have just seen a . case of uric-acid calculus in the ward, and learned that his father had “ gravel or stone for the last twenty years of liis life.” And my almost invariable experience is, that either calculus or gout, most commonly the latter, has been observed in the family of the patient who comes to me with one of these forma- tions in his bladder. I believe it, then, to bo very strongly hereditary. We speak of tubercular disease and of cancer as being transmitted by blood relations, especially the former ; but I do not think even it is more certainly hereditary than the disposition to uric-acid deposits in one form or another. I make a point of * The deposits of oxalate of ^deration of the latter becomes lime and of uric acid so often replace each other that the cou- practically generally siitlicient for our purpose.