(f.) Serous and synovial cavities.— These cavities occasionally contain calcareous pro ductions, evidently produced by the deposition of saline matter in a pre-existing organic basis. This basis, commonly effused fibrin (when the concretion has been free from the moment the process of saline deposition com menced), has in other instances been the sub stance of fibrous tumours once attached be neath the serous membrane, and accidentally set free.
(g.) Similar bodies are occasionally found in connection with the fibrous membranes. Andra] ± describes a very interesting case of tumour of this kind attached to the tentorium cerebelli.
(h.) Cerebral.— A concretion taken from the brain analyzed by Lassaignet was found to be composed almost wholly of fibrin, of a small quantity of cholesterin, and of 4 per cent. of phosphate and carbonate of lime—the evi dent, though rare, result of previous hgemor rhage. A concretion from the cerebellum, exa mined by Simon §, about the size of a nut, of irregular angular form, very solid, both inter nally and externally resenibling a piece of bone, and enveloped in a fine coriaceous capsule, con sisted principally of phosphate and carbonate of lime with a little cholesterin. A similar concre tion analyzed by John consisted of 75 parts of phosphate of lime and magnesia, and 25 of anirnal matter ; another examined by Morin was composed of cholesterin, coagulated albu men, and earthy phosphates.
(i.) Uterine.— Much confusion has arisen from want of accurate distinction of the diffe rent kinds of saline deposition occurring in the uterus. These kinds, we hold to be, three in number. 1. The internal mucous surface may be coated with phosphatic salts. 2. The parenchyma of the organ may contain " ossi form " (really calcareous) globular rnasses re sulting from the deposition of saline matter in the interior of fibrous tumours. 3. The uterine tissue may be the seat of phosphatic accumulation around foreign bodies. These bodies may be either introduced (a) from with out, or (b) enter the uterus from some other part of the genital system. (a) Of the former case Brugnatelli records a curious instance. A calculus weighing about two ounces, of rough surface, and composed of phosphate of lime, was removed from the uterus of a young peasant, and on division found to have a small piece of the tibia of a fowl for its nucleus,— broken off, no doubt, from the entire bone, which had been introduced per vaginam, for the purpose of inducing abortion. (b) Fragments of ketus derived from extra uterine pregnancy, as also moles and hydatids, occasionally form the nucleus or basis of saline concretions.
The Fallopian tubes, too, sometimes contain calcareous concretions. Walther had in his possession a globular calculus of yellowish co lour, a third of an inch in diameter, weighing ten grains, taken from the left Fallopian tube of a woman aged forty. It is extremely pro bable, though not proved by examination, that these masses are, in some instances at least, the remains of fibrous tumours.
(lc.) Pulmonary concretions.— The pulmo nary parenchyma is an extremely frequent seat of concretions. The basis, in which the saline material accumulates, is by far the most fre quently tuberculous ; more rarely the fibrinous substance of simple inflammatory exudation forms its nidus : numerous points of interest are connected with these kinds of concretions, and will be more fully referred to in the section on tubercle. Cancerous substance in the Iung
may become locally infiltrated with saline sub stances ; we have not known such change to occur in blood effused in this parenchyma.
The appendages of the lung are likew ise among the habitats of concretions. Fibrinous exudations in the pleura occasionally form the basis for simple saline precipitation ; or less frequently of' an ossification-process. The bronchi become in very rare instances more or less completely blocked up with solid concre tions, the organic basis of which, in the majo rity of instances, is not improbably (but this point requires further investigation) that mate rial holding a medium position between diph theritic deposit and connmon inflammatory exudation matter, which constitutes the anato mical character of " plastic bronchitis." In a case observed by Gorup-Besanez*, such, how ever, could not have been the origin of the saline accumulation, — at least presuming the chemical analysis to have been correct. Here a coral-like " ossification " was found in the bronchi of a man aged forty-five, as thick as a crow's quill, and extending through the whole length and breadth of the lungs. It broke with a crack; whether it was hollow or not, we are left to conjecture. On analysis it furnished Fatty matters and traces of soluble sal ts 17.17 Mucus 32.46 Phosphate and carbonate of lime, with traces of oxide of iron 50.37 (L) Arthritic. — The substances termed tophi or gouty concretions belong to the pre sent class. Variable in shape, rounded or tuberculated ; of yellowish white or brownish red colour externally, internally white ; vary ing in consistence from soft toughness to very considerable hardness; sometimes unctuous to the feel; and apparently enveloped in a Heller's Archiv. Feb. 1846, or Medical Times, 1946 ; also Tice, in Med. Chir. Trans. vol. xxvi.
delicate membrane ; these productions form within the laminie of the capsules of the joints of the hands and feet, sometimes in the sur rounding cellular membrane, and least com monly in the tendons. Their substance has a chalky look on section.
Their chemical constitution was first made out by Fourcroy and Wollaston ; most cor rectly by the latter. Urate of soda forms their main saline constituent ; with this is as sociated urate of potash and lime in small quantity, chloride of sodium in good propor tion, and animal matter.
A gouty calculus from the metacarpus of a man aged only twenty-two, examined by Lehmann, presented innumerable four-sided prisms, arranged in stellar groups, consisting of urate of soda. The composition was as fol lows :— Urate of soda 52.12 Urate of lime 1.25 Chloride of sodium 9.84 Phosphate of lime 4.32 Cellular tissue 28.49 Water and loss 3.88 The abundance of urate of soda in these calculi is a very remarkable feature in their con stitution ; and points to the probability of that salt existing in the blood of gouty patients.
(m.) Cutaneous.— The natural secretion of the sebaceous glands may be retained within those sacs in consequence of accidental closure of their orifices. And if the saline materials predominate much over the organic, either as a fault of original secretion or from inspissa tion, a concretion is the result. Epithelium and fatty matters of various kinds are always associated with the saline materials. These saline materials, which vary much in their per-centage quantity, are mainly phosphate and carbonate of lime.