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OF LITHONTRIPTIC S. LITHONTRIPTIcs are medicines supposed to have the poweros dissolving urinary calculi : their operation, it is obvious, must be purely chemicat. The athalis, it has been long known, relicue the patiata sympionis arising froni these calculi ; and it was found by experiment, that they are capille of dissolving these conor tions out of the body ; heiace it Was concluded, apparently vitu justico, that their essica dependa ou their solvent
Tho discoverios of Modem Chemisto have thrown fa thor liit on this subjeci; it has been proved that these uri-xary concretiona consist frequently of a peculiar animal acid, the lithic or uric acid, either nearly pure, or in a state Mintermixture. With this acid, the allialis, in their pure state, are capable os combining, sol ing a compotand solubie
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Their solvent potver is thus imputred ; but stili in this mild krm they retain the power of preventing the lucrense of thetiri nary concretion. The dep ition os uric acid, to whichthat increase is owing, dependS iu a great measuve on thegeneratioti os acidi ty in the primae viae. The acid whicli isthcre formed passos oss by the kidneys, and causes the precipitation of the urio acid ; the use of the alhaline carbo- nates, is correcting this acidity, prevenis this deposition,
and of coui se prevenis ille increase of ille Urina coner
tion, and lessens the irritating quality of ille urine. It hax accordin y been soliud, that under a Coui se of aikalino remedios, the deposition of uric acid, So frequently abundant. Doni the urine of those who are liubi e to calculus, diminishos rapidiy. Vith this in tention, moderate doses of the ut hali
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It had always been known, that urinary calculi are nutos uniform appearance and qualities. Dr WOllaston's T Searches proved, that they are of very different chemicia Constitution, and his experiments were confirmed by those of Fouror' and Vauquel in.
Besides the uric acid calculus; whicli is genera Ity of n
lamella ted structure, son and sinooth to the touch, and giving a licti powder of a brilliant whiteness. This, the fi sibie calculus, as it has' been nam , is not solubie in alkaline solutions, but dissolves very casib in diluted acidue audit melis hei ore the blowpipe into tui enaniel. The substance composing it is phosphate of magnesia and ammonia, and though it seldom forins an entire calculus in iis pure state, itis osten intermixed with the other usual ingredients, di posed with these in alternate layerS. Phosphale of lime fornis another variety of calculuS, SOm times alone, but more generalty mixed with urio acid, Drmith phosphate os magnesia and ammonia. Calculi of this kind havo usualty no meat induration, feel dry an a rough,
and Ire without any lamellated or spathose structure ; in nre not dissolved by the allialis, but are solubie more or les. in diluted acilis. Lastly, a calculus had been known to surgeons, under thena me or Muthei Calculus, derived Doni iis purplisti colour und iis rough irregultae sui face. Tins is cum poscit princi-
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pally os oxalato os limo, with portions os urio acid, phosophate of limo, and animal matter. It is hardor and heavior than any of the others ; and is tess affected by the usual solvenis, athaline Solutions havmg no effect upon it, and seids dissolving it with great dissiculty ; the aikaline carbo-
nates glowly decompose it. Froin these diversities in chemicat constitution, among the urina concretions, it is obvious, ita at we cannot expectu isorm advintage froin the use of any active solvent as alithontriptio, since what dissolves one calculus will have noeffect iapon another; and Cases have accordin y occurred,
ere, instead of relies bring obtained, as it frequently is,froin the use of aikalis, it has been obtained noua weadaci Is, while in many casos they have been productive os no
A particular murce of dissiculty has sarther been potntedout by MY Erande, attending the attempt to exhibit lithon-
triptios as solvents. The phosphates of lime and magnesia, whicli exist in the urine, are retalaed in solution principallyby iis excess of recid: is, there re, With the view of dissol ing a uric acid calculus, or preventilag iis increase, aikalisbe' gi ven go as to neutra lige this acid, the deposition of thesephosphates may be favoured, and a layer of them may evenseum on the existing calculus. And there is reason to belleve, that ille Sofinem and sponginess Which have been ObseYved not utilaequently on the sui face or calculi, in patienis ivlio have continued for a long period the use of eskalis, and Which have been rogavded as prooss of at least partiat soli tion, have arisen Dona a deposition of this Lind. I on illeother hund, si'om the state of the urine, or hom the information amorded by a s mali calculus bcing discliarged, there
sisted chieny os phosyliate os ammonia and magnesia, is V e
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attempted the solution of this by the administration a wcula aclds, we run the haχard of causing the deposition os urii acid. It is accordin y und, that these e eis talae Issaco. In different cases it has been rem Led, that when allialis have been given to correct the deposition os urio acid, or thered sediment or graves Dum the urine, they have, When continued too long after having produced this effeci, caused the deposition of the restite sediment or gravet, the phosphate Gfammonia and magnesia ; and on the other haud, Ain Brando has remarhed, that When actas ivere given with the vie vos removing the deposition of the phosphates, they have, anter Some time, caused a separation a uric Mid. These ci Cumstances render it necessary to emplOy these remedius with caution, and with a strict attention to their operationeven as palliatives, and seem tu a great mensure to precludetheir use aS SolVenis, Since We Can Scarcely liope, even hyan alternation of acids and allantis, so to adjust them as to. obtain to any extent their solvent est is, without these
There is another mode, in whicli it has hoen supposed that lithontriplics may exert a solvent power. In ali urina calculi, there exi sis a quantity of animal mattex, Supp edto he of the nature of alhumen, Whicli has been regarded asthe cementing ingredient, giving indui alion to the calculus. On this it has been conceived Solvents may aet, SO RS to destroy the cohesion of the aggregate. The eXperiments of DrEgan confirm this, he having found that limo-water is more effectuat in destroying the cohesion os a urinary calculUS, than an alliatine solution, a result whicli, on repeating his experiments, I have likewise obtained. Nou , this super orit7 cannot be ascribed to any action os the lime on the Sa-Jine ingredionis os ille calculus, but must arise Pather si Omhis chemicat action on the album en or unimal mucus, DI
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464 LITHON TRIPTI CS. ivllicli it is known to he the solvent; and it may thero rebe supposed that lime-water, Dona this operation, might housed with ad tantago as a lithontriptio. It would os coursevequire to be given in combination ivith aikalis, the lalter neutrali ring the excesA of acid in the urino, ivhich wouldotherivise combine with the lime, and rendor it inert. Eutit may be doubted is this could be managed, so as to obtatu any important effeci, or that lime could be secreted in iis
Froin these observations, the advantages to be expected
Boin lithontriptios, it is obvious, must be very limited. They probably cannot be given with greater benefit than
simply to correct the excess of acidi in the urine, so frequent in those who Iabour under calculus, and thus diministior remove that deposition os gravel as it is named, or smali crystalline grains, whicli osten proves a So Ce of irritatiou. They may even thus perhaps provent the increase in the figeos a concretion. or it is possibie, in cases of the mciber
calculus, wluch produces much pain ironi iis rough and po inted sui face, that pushing the use of them even a litile sarther might prove useful, by giring rise to the formationor a I ex of the phosphate os ammonia and magnesia, whichwould ut least render the sursace of the calculus sost and Sinooth. Lut We can nevor liope, by even the most caret ut administration of them, to dissolve a calculus of any Sige. In their administration, it may be of advantage to attend to the State of the urine, so sar as regariis iis chemicat constitution, and to Suspend or vato ille rem dies as this may change. Aud in ali cases the continuauce of the remedies, and the
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POTASSA. Potasti. Page 372.)Tuis eskali is used as a lithontriptio, cither pure or cona-bined with carbonic acid. The puro aikali' in tho statu os solution Oq. Ροtassae) has been given in a dose of 15 or 20 drops, moxning and evenium incaeeasing this gradually asser as the stomach can hear it, untii the urine is renderedathaline ; and at the samo time diminishing the irritation itis liable to produce, by tho Deo use of diluenis, and of any mucilaginous or gelatinous liquid. The action of the puro potasti heing more p0 verses than that of the carbonate on uricacid calculi, it is undor this forin that it his been employod when the actuat solution of the calculus has beeu attempted.
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466 1 1THON TRIPTIC S. Independent, howevor, of the dissiculties which attend this.froin the circumstances Which have been po ted out under the generat observations on the action of lithontriplics, it is Scarcely possibie to continue the use of the pure assiali tothe requisite extent, Dona the irritation it occasions both in the stomach and bladder; and when it is to be used as a palliative, it is heiter to emplo it under the serm of the
The super-carbonaled potush water, alveady noticed, page 455.), affords the most effectual palliative in cases of urinary calculi; the relies obtainod hom it appears to ariSesrom iis neutraliging the Dee acid in the urine, and thuS rendering it less irritating. Froni half a pound to a pomad isgiven in the courge of the day ; and it has the important ad-Vant age, that, froni iis militia ess, it can be continued for mylongili os time without relucta iace. There is another ad-Vantage perhaps belonging to the Super-carbonated athalis compared with the puro aikalis. The lattea , is pushed too far, are ii te to occasion the separation of the earthy phosphates froin the urine ; and where the urine is in that state in Whicli these prodominate, they must prove injurious. Lut
cid will rotain the phosphates dissolved, for this effect is obta ined even front watex impregnated with carbonic acidulone ; and thus est the advantage that can be derived Domitie athali Will be obtained, without the injurious consequences that may arise hom the use of it in iis pure forna.
bouate, is oblatued Dum the barilla os commerce bdi solutiou
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In water anil crystalli atton. The crystals contulit halitheir weight or water of crystalligation, and are Soli te iutivo paris of cold, and in an equat part os bolling Water. This crystalliZed sali assordes a very excellent sorm i indexwhicli the aikali may be administered, so as to give the nil vantages of a palliative, and whicli is leges expensive rhan a nyother. This sorius ivliat has hcon numed the Sod a Pili. Thoc Stais are expoSed to a very gentio heat, untii they losethela water of crystallii Zation, and the dry puxvder is maduinto pilis with so . of these, half a drachm or a draclitu
hard ; and to serui the purer soap whicli is fit sor modicinaluse, it is combined with the militest vegetable eXprossed oti, as that a the olive. The soap is White, but soni times isdesignedly coloured by the addition to it, While sost, os a solution os sulphais of iron. 'The acrimony of the athali is much diminished by iis combination with the oti, and on this account soap has been preferred as a lithontriptio, one or two ounces being taken in the coui se of the day. Froin the oti it contains, hora evor,it is nauseolis, and in Sucti large doses generalty offenSive tothe Stomach, und the super-saturation utith carbonic acid af
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useful by correcting acidity ; but in the sinali quantity in
whicli it cata be talaen, it can scisceb be supposed, that myos it ivili ho secreted by the kidneys, so as to change thei omposition Os the urnae. Mere it secreteil, indeed, it wouldhe rendered insolubie by the Dee phosphoric and urio acias. Tho ouly method in Whicli it could be brought to aci on a Calculus, would be by conjoining iis administration ivitii that of tho aikalis, so that the urine Should he vendered altaline. This combination constituted the celebrat ed remedies of Stephens; but even with overy precaution, it may be doubt-ed is the limo could be made to exert any real lithontriplic
measure confine i to their neutraliging acidity in the stomach, as above explained, magnesia has been employed ser this purp0se m equalty effectual, and as possesSed of sonae peculiar ad vantage Over the aikalis. From iis insolubility it ivili rem ain longor in the stomach, and DOm this, it has boon sup- posed, Wili more certainly neutraliZo the acid; it has accord- ingly been usti ed on the authority os IIr Home, thatit diminishes more effectualty tho deposition of iurio acidsrom the urine ; and sonae cases have bocii stat ed by JUr