and they have been occupied in ascertaining the process of calculous formations, with the view of administering such preventive medicines as may indispose the system to produce those concretions, or check their growth, without altering the tone of the constitution. The papers now before us throw considerable light on this important subject; and contain also a good deal of information, tending to elucidate the fallacies of the older doctrines respecting solvents. Indeed, did we not know the danger of trusting to medical reports of cures, and did we not recollect how regularly a series of cases, all quite apt and most nicely fitting the doctrines, forms a part of every modern treatise on medical subjects, we should be tempted to consider a great part of the question solved with regard to the stone, and should confidently look to the extirpation of that worst of maladies. Even moderated by such unpleasant recollections, as we own our hopes to be, we cannot look to the eminent names prefixed to these tracts without great respect; and we feel at least so much inclined to listen, that we shall make no farther apology for laying before our readers an account of what the papers have added to the stock of our knowledge on this subject.

In order to convey some idea of the greatest degree in which this disease has ever yet, we believe, been known to afflict its wretched victims, we shall begin with noticing the case narrated in Sir J. Earle's paper.

Sir Walter Ogilvie, a Scotch baronet, received, at the age of twenty-three, a severe blow on the back, from the boom of a vessel; and the pelvis and lower extremities were in consequence paralyzed. He remained in bed for fourteen months, in an horizontal position; and, during the first two months, his urine was of necessity drawn off by a catheter. After this, he had somewhat recovered the use of his limbs, and could walk or ride, though with difficulty: his general state of health, too, was weak and precarious. About twenty years after the accident, he was afflicted with symptoms of stone; and, upon examination, a calculus of considerable size was found to have been formed in the bladder. An operation was now recommended, but, unfortunately, delayed from time to time, although the patient's health constantly declined, and the irritations and pains in the bladder greatly increased. In this melancholy state he continued for eight years longer, when he became unable to make water in an upright position: he was obliged to place himself in an inverted posture, that the upper part of the bladder might become the lower; and as, even by this means, very small quantities of urine only could be voided, the irritation of endeavouring to make it became almost perpetual, and he was obliged to perform the above men

tioned operation every ten minutes, with scarcely any relief. The principal remedies which he tried were aqua cal is and wou ursi. He used opium also to alleviate the pain; and this, adding to a naturally costive habit, rendered aperient medicines frequently necessary, which, again, must have increased the irritations of the disease. At the age of fifty-three, thirty years after the accident, the spasms became so constant and so violent, that he resolved to have the operation performed; and the paralysis of the lower parts being deemed no obstacle to it, he was conveyed by sea to London, where Sir James Earle and Mr Cline consulted upon his truly lamentable case, about the end of July 1808.

Upon examining the lower part of the belly, a tumour was perceived, so large, that Sir James Earle doubted its being altogether caused by the stone; but, on sounding, the instrument would not enter the bladder; and further examination showed, that the whole cavity was nearly filled with calculus. It was clear, therefore, that this could only be extracted, if it should prove soft enough to admit of being broken, and thus brought away piecemeal; and it was deemed impossible to attempt the operation above the os pubis. The ordinary method was therefore resorted to; and, after some days consideration, Sir Walter Ogilvie, well aware of the difficulties of the case, and of its great uncertainty, yet justly weary of the long life of torment which he had led, was resolved to have the operation performed, for the chance which it afforded of bringing a relief, only otherwise to be attained by death. It was accordingly performed by Mr Cline, on the 11th of August.

He was placed in the usual position, and the ordinary ligatures were applied; but the paralysis of the lower limbs rendered it unnecessary to confine them, and they were left at liberty. It was found impossible to pass the staff, or any kind of forceps, into the bladder; but, on pressing hard with the finger, part of the stone felt soft, and gave way. This making room for the forceps and scoop, some parts of the concretion were brought away; and, in this manner, about a large teacupful was extracted. The great mass, however, continued hard and immoveable: it could neither be broken nor shaken from its position; and, after trying every instrument, of all powers, the operator was compelled to desist, leaving it (with the exception of the soft matter brought out) in its former state. The patient bore this long process with great fortitude: happily, the paralysis of his lower regions may be supposed to have somewhat diminished the sensibility of the parts. He was, however, completely exhausted, from weakness and fatigue.

Although no hemorrhage, nor any fatal symptom, appeared

to result from the operation, it had afforded no sort of relief; and the spasms continued as before. They soon increased in frequency and effect, as he became exhausted, and unable to stand them. He seems to have had a gleam of hope on the morrow of the operation; for he frequently inquired when he might be well enough to have the remainder extracted. But he gradually sunk under the repeated and violent irritations of the spasms. On the eighth day, his pulse became smaller and quicker, and he could scarcely be prevailed on to take any sustenance: on the ninth, he was more impatient, feverish and restless; and, on the tenth day, he desired not to be teased to take any thing more; when, covering himself completely with the bed-clothes, he quietly resigned a most singularly miserable existence."

On dissection, the bladder was found to be quite filled with a huge calculus, composed of the triple phosphate, which we shall afterwards have occasion to speak of; and of such an unusual proportion of animal matter, that it speedily showed a strong tendency to putridity, and even engendered maggots. It weighed forty-four ounces, or three pounds four ounces, apothecary's weight. Its form was that of an irregular ellipsoid; the larger circumference being sixteen inches, and the smaller fourteen. It had filled the bladder, and taken its shape, but apparently without distending it. The ureters had become enlarged, so as to contain the urine, and act as small bladders; while the large bladder only permitted that fluid to pats off by means of small furrows which it made in trickling along the surface of the stone, between the stone and the bladder. There appears no reason to doubt, that, in a short time, even this painful and insufficient operation would have become impracticable, by the further enlargement of the stone stopping up the mouths of the ureters; in which event, death must have ensued from suppression.

Such, in its very worst state no doubt, is the dreadful malady which forms the subject of the chemical papers now before us. To these we must now direct our attention; and we can promise the reader sufficient reward for his trouble, if he shall be pleased to follow us through the analysis of their contents.

Mr Brande's valuable paper, which stands first in the prefixed list, is founded on an examination of the collection of calculi contained in the Hunterian Museum. Beside the known richness of that collection, most of the specimens have histories of the cases annexed to them, which are obviously of the greatest use in the investigation of the subject. Mr Brande arranges calculi into four classes-first, Those which are formed in the kidneys, and voided without undergoing any change in the passage; second, Those which are retained in the kidneys; third, Those

which are found in the bladder; and, fourth, Those which are found in the urethra. On each of these species, our author has made a number of experiments; and the results exhibit a sufficiently distinct account of their chemical analysis. The first class, or calculi of the kidneys, consist almost always of uric acid (the Lithic acid of Scheele) and animal matter;-the animal matter is found in various proportions, from one-eighteenth to one-third of the whole compound. Sometimes the acid and the matter are not formed into a solid calculus, but pass off mixed with phosphates. The author, however, is disposed to think that the phosphates are not elaborated in the kidney, but mingle with the calculous matter in its passage. In some few instances, the calculus contains oxalate of lime; but this is very rare. The size of these calculi varies, and one has been described by Dr Heberden so large, as to weigh twenty-eight grains; but it may have been detained on its passage, and so augmented in bulk. The largest which Mr Brande examined only weighed seventeen grains. All the calculi of this class are certainly soluble in pure potash; but it is needless to add, that the caustic qualities of this substance render its application in the living subject impossible.

The second class is formed by the detention of a calculus in the kidney, while either the secretion of uric acid enlarges its bulk, sometimes so as to form a complete cast of the pelvis of the kidney; or the stream of urine to which it is exposed deposits the phosphates upon the original nucleus of uric acid and animal matter. In the one case, we have an enlarged caiculus of the first class-in the other, a calculus of the third class, only detained in the kidney.

When the uric calculus passes into the bladder, and is there detained, or when a calculus of oxalate of lime comes down from the kidney-or when portions of fand or animal mucus are deposited in the bladder-or when any extraneous substance has found its way thither and is detained--in all these cases, that is, on all these substances as nuclei, there are formed calculi (commonly termed stones in the bladder) with greater or less rapidity, according to the tendencies of the constitution. They may be ranged into three subdivisions-those composed chiefly of the uric acid-those chiefly composed of phosphates (the ammoniacomagnesian phosphate, or phosphate of lime, or a mixture of the two); and those containing oxalate of lime, which are commonly termed mulberry calculi. Messieurs Fourcroy and Vauquelin, and Dr Pearson, having found the greater number of calculi to be composed of uric acid (that is to say, belonging to the first of these subdivisions), our author was surprised to find that, in

the Hunterian collection, this proportion did not hold: for, of a hundred and fifty which he examined, only 16 were composed of uric acid wholly (beside the animal matter),-45 of that acid with a small portion of phosphates,—and 5 of the acid with phosphates and nuclei of oxalate of lime; while 66 contained phosphates with a small admixture of uric acid,-12 the phosphates entirely, and 6 chiefly oxalate of lime. Observing that a greater loss was sustained in obtaining uric acid from calculi in the bladder, than from calculi in the kidneys, Mr Brande was led to conclude that the former contained urea. With a view to ascertain this point, he made some experiments; and found that an uric calculus, weighing 60 grains, contained 5.2 of urea and muriate of ammonia, 6 of ammoniaco-magnesian phosphate, and 48.8 of uric acid-but no urate of ammonia could be detected: from whence, and from other experiments, our author infers, that this substance, when supposed to exist in calculi, owes its origin to the development of ammonia, and its recomposition with uric acid in the course of the processes of decomposition. The mulberry calculi (which are rare) contain, in general, a considerable admixture of phosphates and uric acid with the oxalate of lime. The very large calculi often contain an agglomeration of different species of calculi. MrBrande examined one, of twenty-three ounces and twenty-six grains, which had a nucleus of uric acid, surrounded with a considerable quantity of very pure ammoniaco-magnesian phosphate the mass of the stone consisted of mulberry calculus. Another, weighing 154 ounces, had a nucleus of uric calculus, round which was a mass of ammoniaco-magnesian phosphate, intersected with lamina of uric acid. It is rare to find calculi composed of four distinct substances. Our author saw one which had four separate layers, or strata, of uric acid, oxalate of lime, ammoniaco-magnesian phosphate, or phosphate of lime. He examined four calculi, the nuclei of which were extraneous substances, viz. a garden pea, a needle, a hazle nut, and part of a bougie. Besides the animal matter, the first calculi contained phosphates only; the second, phosphates and oxalate; and the other two were also destitute of uric acid.

The fourth clafs of calculi, thofe found in the urethra, offered no peculiarities to the obferver. Indeed, the claflification of Mr Brande does not refer fo much to any diftinct properties of the fubftances arranged, as to their pofition and accidents-their habitat, as the botanifts exprefs it; for their properties feem to depend merely upon their expofure to the urine in the different stages of its elaboration; nor is there any manifeft variety of circumftances affecting their formation, except in fo far as they are found in ftreams of that fluid in its nafcent or in its perfect ftate. The VOL. XVII. NO. 33.

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