Localization of pain in renal lithiasis, based on analysis of 259 cases of renal calculus. The simple cases, those who did not suffer crises of colic, were gen erally characterized by pain correspond ing almost exactly to the situation of the kidney. In 75 cases bilateral lum bar pain was present, and often consti tuted the- only symptom of calculus. Unilateral lumbar pain occurred 15 times, generally in attacks of colic, and associated with other manifestations. Abdominal pain, which, in infants, in volves the whole abdomen, and is the chief factor in renal colic, was found in adults most acute in the hypogastric and umbilical regions. Abdominal pain occurred alone in 7 eases of the series; associated with lumbar pain, but with out true colic in 26, bilateral in 9, uni lateral in 17. Pain in the ureter alone was observed in 10 cases, unilateral in 6, bilateral in 4. Of these 10, 9 were proved to have been caused by oxalate calculi. Hepatic pain, without gall stones as an accompanying condition, was present twice. Genital pains are recorded in 15 cases, bilateral, and al ways associated with other localiza tions. Pain was found once over the iliac bone, unilateral S times in the thigh, G times in the area of distribu tion of the femoro-cutaneous nerve, twice in that of the obturator, and twice in the urethra. Apart from pain, total abdominal hypemsthesia was ob served in 2 cases, and abdominal anal gesia in 5, of which 4 were unilateral, involving the hypochondrium especially. True colic, paroxysmal lumbar pain ex tending to the thorax and along the ureter, with vomiting of food and bile, was seen in 74 cases. Constant (Brit. Med. Jour., from Rev. Med. de l'Est, Jan. 1, 1901).
From the examination of 136 cases suspected of having renal or ureteral calculi, and the detection of 19 cases of nreteral and 17 cases of renal calculus, these conclusions are drawn: Both the negative and positive diagnosis by the Roentgen method are accurate and valu able. Ureteral calculus is much more common than has been supposed, or about 50 per cent. of all cases of cal culus. It is impossible to arrive at as accurate a diagnosis of calculus by other methods. This method is comprehen sive, and aids operative intervention by localizing all calculi and excluding cal culi from the other kidney. Non-opera tive treatment, with a negative diagno sis by this method, is irrational and dangerous in cases that are at all sus picious. The method is precise, because its results are mechanically produced, but that accuracy in its employment and care in reading the results are necessary to the avoidance of error. The data obtained by this method make 11 on - o pera t ive, conservative treatment rational in eases of small calculi low down in the ureter that can be expected to pass. The negative diagnosis does not preclude exploratory nephrotomy. but does make unnecessary the actual incision into the kidney in search for calculi. Dilatation of the ureter with bongies, as has been practiced in the female, may be employed in the male by utilizing a suprapubie eystotomy wound to guide the instruments from the urethra into the ureters. C. L. Leonard (Annals of Surg., Apr., 1901).
Etiology and Pathology.—Renal cal culus occurs most frequently in males, before the age of 15 and in later years of life. Its formation depends upon the gluing together of crystalline particles or amorphous salts in the urine by col loid material from blood-clot or mucus. The masses thus formed vary in size from sand to that of a hen's egg; some of them assume the shape of branches of coral. The nuclei of calculi are said to consist most commonly of ammonium urate in children, uric acid in adult life, and cal cium oxalate after the fortieth year. The phosphates, cystin, and xanthin less fre quently give rise to renal calculi.
A small stone may be lodged in healthy renal tissue, giving rise, perhaps, to bleeding, congestion, and inflammation and various nervous symptoms; or it may cause the formation of an abscess in the substance of the kidney. Gravel may pass from the uriniferous tubules and be carried away by the current of urine with out causing symptoms. A small stone may pass along the ureter with dfficulty, causing renal colic; it may remain a movable body in the pelvis, by its irri tation producing pyelitis or by stopping the ureteral orifice produce hydrone phrosis; or it may be lodged in the pelvis or calices, forming a large, sometimes branched, calculus and give rise to in flammation, suppuration, and thickening of the tissues about it.
Treatment, Medical.—During the at tack of colic the patient is to be given the hot bath and hot drinks of lemonade or soda-water, while hot fomentations are to be applied to the loins. If these meas ures are insufficient to bring relief, mor phine or even chloroform may be used.
Between the attacks attention must first be directed to hygienic and dietetic measures. _Moderate exercise is to be taken daily in the open air and the pa tient is to lead as quiet and temperate a life as is possible. Overeating and in dulgence in alcohol should be prohibited. Large quantities of water, either mineral —such as lithia, Poland, Carlsbad, and Vichy—or distilled, are to be taken daily.
The bicarbonate or citrate or potassium given in 1-drachm doses in a tumblerful of water two or three times daily, or the benzoate or carbonate of lithia in 5-grain doses three times a day are of value. Piperazin is claimed by some to be a solv ent for uric-acid calculi and may be hibited in 5-grain doses three or four times daily.
In renal colic local measures consist of hot applications. Prolonged hot baths accelerate the crisis and promote diuresis caused by mineral waters. They are use ful in moderate eases, but, when there is much vomiting and struggling, their ac tion is only limited. Complete immer sion is better than partial. The tempera ture should not be less than 93°, and if not contra-indicated may be gradually raised to 104° F. When there is intoler ance of drugs by the stomach they should be given by the rectum. Anti pyrine is especially useful. Injections of laudanum, 10 to 20 drops, may be used after first washing out the rectum. In halations of chloroform or ether may be used when there is danger of abortion, or when the nervous symptoms are ex aggerated. Marboux (Lyon MM., p. 407, Mar. 21, '97).