A disquisition of the stone and gravel, together with strictures on the gout, when combined with those disorders; pointing out a safe and efficacious solvent for reducing the stone, and correcting the calculous diathesis in the habit / by S. Perry.

  • Perry, S. (Sampson), 1747-1823.
Date:
1815
    the pubes ; laterally, it is fixed by produc- tions of its external covering to the other bones of the pelvis ; which bones are the os pubis forward, the os sacrum above, and coccygisbelow; backward, with the iliaabove, and the ischia below, laterally. In males, the bladder posteriorly is firmly connected with the rectum from the entrance of that gut into the pelvis, tillVithin a short dist- ance of its termination in the anus ; when the neck of the bladder and commencement of the urethra separate a little from the gut, which space is filled with fat and cellular substance. The inward membrane of the bladder is well furnished with nerves, and consequently of exquisite feeling, but it is defended from inflammation, and from the too great acrimony of the urine, by the vast number of glands surrounding it, from which continually oozes out a mucus for the purpose of lubricating it. From the too frequent making water, however, we observe this mucus washed away with the urine before it has acquired a due consistency in the bladder ; although, when out of it, it will become glutinous, and sometimes hang in ropes to the chamber-pot. § IV.—THE URETHRA. The urethra comes off nearly at right an- gles from the anterior part of the neck of the bladder. It is a cylindrical membranous canal, the first portion of which, from the bladder to the bulb, is surrounded by the
    prostate gland, which is of a flat pyramidal shape, with its base turned towards the bladder, and its apex pointing to the peri- na*um ; its superior lamella? being connect- ed with the pubes, and its inferior with the anterior and under part of the rec- tum. This gland is frequently injured in a gonorrhoea, and thereby lays the founda- tion for future great perplexity and confu- sion ; it being sometimes difficult to distin- guish its disease and symptoms from those of the neck of the bladder itself. The rectum too, by sympathy and contiguity of situa- tion, often participates in its uneasiness ; and if this intestine happen to be affected by he- morrhoids, it is sometimes suspected to be the chief seat of the complaint. The urethra continues to be wholly membranous for a short space after it leaves the apex of the prostate gland; and this part of it keeps in close contact with the ossa pubis, till it passes out from below the arch formed by these bones, which it does by making a curve in its progress to the peri n sc urn. A facility in the operation of sounding is ac- quired by the operator attending to this - curvature in the urethra, the not doing which has often created difficulties, and un- easiness in the mere introduction of a bougie up the passage. A good anatomist.will, in general, pass a catheter or staff with ease, while one less expert will not only give un- necessary pain, but be apt to fail altoge- ther.
    The urethra, after it has passed the bulb or protuberance before mentioned, and which is, technically, called Corpus Spongiosum, proceeds along in a more diffused state through the corpora cavernosa to the ex- tremity of the penis ; whereby, expanding again, it terminates in the nut or glans penis, which may be considered as crowning the three spongy pillars. The canal of the urethra is lined by a fine membrane, full of capillary blood vessels, and its surface is perforated by a great num- ber of oblong holes, or small lacuna? of different sizes, the largest lying near the glans. The cavity of the urethra resem- bles in its natural size that of a small writ- ing pen, but, like the ureters* is capable of considerable enlargement, so much even as to admit a stone of the bulk of an almond to pass through it by degrees and by skilful management. § V.-OF THE URINE. After having described, in as brief a man- ner as possible, those parts which are parti- cularly concerned in this formidable disease, being in fact the seat of it, we proceed to treat of the urine, which so copiously affords the matter for the formation and growth of stone. This portion of our subject will ad- mit of, and even require, a more particular consideration, as containing at all times and in all persons, healthy or otherwise, the rudiments or principles of a stone. 13 2
    In strictness, it is not intended to deny that the other fluids of the body may con- tain the same rudiments of stone also; but it does not appear front experience, that, with- out the accession of some other cause, or a more powerful concentration of their parti- cles, stones do form in them ; whereas daily observations teach us, that the work of con- cretion once begun in the urine, is liable to continual augmentation, till the whole inter- nal cavity of the kidney or bladder be filled with it, and the course of the urine thereby interrupted. In confirmation of this fact, it may not be thought unseasonable or improper to cite the remarkable cases of the late Duke of Northumberland, and of Sir Thomas Adams. In the first of these it was known to all the medical men who had been consulted by his G race, that the left kidney was entirely filled with stone. Its office appeared to be com- pletely destroyed, and the surrounding re- gion of it had felt cold and benumbed during the last three years of the Duke's life. The secondhnstance is strikingly illustrat- ed in the case of Sir Thomas Adams, Lord Mayor of London; who was, notwithstand- ing, so abstemious and temperate in drinking, as that for forty or fifty years, when at pub- lic feasts, he never exceeded a pint of wine, always concluding with a glass of Canary. In lire ordinary mode of living, he drank constantly every morning a large draught of small beer with sugar.
    However, for many years he felt at times a pain iu voiding his urine, which he did by drops, and with (what the historian of his case calls) a degree of acrimony. For many hours before he died, he had manifested no desire to make water, and seemed to suffer no pain by the distention of his bladder. A few days previous to his dissolution, he #was very much inclined to sleep, no less so than if he had taken medicines for that pur- pose. He died in 1667, in the eighty-second year of his age. On being opened by Mr. Ilollier, an eminent surgeon, no urine was found in his bladder, the cavity of which was wholly filled with a stone of an astonish- ing size, weighing twenty-five ounces and a.r half. But what was most remarkable in this- stone was, that, where the ureters are insert- ed in the bladder, the urine had formed itself a semicircular channel or groove, from the middle of which another was made by the trickling of the urine into the urethra. The relation of this case is as given by Sir William Adams, his son. The stone is to be seen in the laboratory at Cambridge. The exact delineation of the stone, with the representation of the gutter the urine had formed, is exhibited also in one of the numbers of the General Biographical Dic- tionary, but which of them cannot tow be recollected. Numerous other^cases, similar in almost the same degree, might be referred to; yet the above being so unequivocally laid down, and so indubitably ascertained in