THE GRAVEL.
Underthe head of this disease may be classed all those urinary affections, wherein a sandy deposite is observed, after the urine has stood some time. This sandy excretion varies in its composition, in the quantity voided, and in its continuance: and it is also often separated, for it is held generally in solution in the urine as it comes from the bladder, while in the bladder or in the kidneys; and hence we find gravel in the kidneys, in the bladder, and in the urine. Where it is precipitated, or formed in the kidneys or bladder, it is apt to accumulate, and constitute what is called “Stone” in those organs. As I have just observed, the composition of this gravel differs, and differs also at different times in the same individual, according to circumstances. Stones have been detected that, like the rolling snowball, gather up, as they increase in size, whatever comes in their way; and, accordingly, as the deposites are principally composed of concretions, termed, in chymical phraseology, “Lithates” and “Phosphates,” stones are frequently found to be formed, first of a layer of one covering, then of another, and so on.
Gravel may exist for years without inducing much disturbance of health, or it may produce serious inconvenience in a very short time. The urine being acid, holds the salts which it contains in solution; and, therefore, if the acid predominate, it becomes, through its own excess, thrown down, when it is detected in the form of red sand; but if there be an insufficiency of acid, the earths and salts of the urine are thrown down, and they exhibit their existence in the form of white gravel. Hence the two names “Red” and “White Gravel.” Acidulated urine is looked upon as certainly indicative of health, and when in excess, of a high tone of health; which, as the degree ascends, is marked by inflammation and fever. Alkaline urine betokens feebleness of constitution, or interrupted health. High living and an excited life induce red gravel; irregular, or an impoverished living, with much mental inquietude and physical exhaustion, establish white gravel. The fact of gravel being known to exist without forming stone, is no justification to suffer it to incur even the chance of such a finale. There is no class of diseases so painful and distressing as those wherein the function ofthe kidneys or bladder is interrupted, and the majority of these affections are ushered in by a derangement of the urinary fluid.
Cause of Gravel.—The cause of gravel is owing to chymical affinities. The urine, among its other constituents, containslithic acidandammonia, which two, in healthy urine, are combined and held in solution. If any other acid, as may be instanced in expelled urine, possessing a greater affinity for theammoniathan thelithic acid, be added, thelithicwill be thrown down. The same process takes place when effected in the system, the source of which new acid is the stomach, which, when in an irritable and feeble state, as in indigestion, furnishes or abounds with muriatic acid. In like manner, the urine containing salts, called phosphate of lime, ammonia, and magnesia, on receiving an additional quantity of ammonia,[18]the lime, for the less affinity to phosphoric acid than the ammonia, is thrown down; and hence a salt, bearing its name, is generated, either to be expelled like gravel, or to feed a nucleus already existing in the bladder. These chymical changes are produced by the causes before enumerated. We are subject to an infinitude of laws: we are perpetually changing, and these changes may fairly be stated as chymical affinities: it is owing to such, that the absorption of fluids, and the deposition of substances, which exist more or less in all derangements of health, ensue—to such, that we resist death, and to such that we become its prey. Gravel is a disease not so productive of fear or suffering, so long as it escapes when formed; but there are so many circumstances that may give rise to the formation of stone, that sandy urine should always command notice and treatment. A clot or point of blood, that may have been discharged from irritation of the kidney or bladder, is often found to form the nucleus of a stone: the slightest substance, once in the bladder, is apt to form a basis for accumulation: a pin, a fragment of a bougie, or any instrument, hair, wood, and numberless other things that have found their way into the bladder, have given rise to the formidable and distressing complaint of stone.
Treatment of Gravel.—It is not to be anticipated that every person is prone to excrete gravelly urine, else certaindietetics, that evidently give rise to the same in particular instances, had better at once be removed from the list of articles of food, and their use prohibited altogether; but there are instances where a constitutional disposition exists in particular families, that is even transmitted from generation to generation, to calculous diseases, and in those cases, every precaution should be taken to avoid even their development.
The antidotes to the disposition to gravelly urine are, exercise, temperance, and the adoption of all those means that tend to promote a healthy action of the skin and kidneys, namely, the warm bath—it is a perfect talisman in these affections—it needs but little eulogy; the comfort and relief, where relief is sought, afforded on the first experiment, best bespeak its praise. It is decidedly one of the most useful adjunctive prophylactic measures we have.
I have already stated, that disorders of the urine arrange themselves under two great heads—the acid and the alkaline prevalence. The treatment is to neutralize the excess of either: the acid diathesis, as it is called, is considered a less healthy deviation than the alkaline, and is looked upon as indicative of greater constitutional break-up. The medicines most in vogue in gravelly disorders are, turpentine (to increase the formation of lithic acid), sulphuric, nitric, and muriatic acids; while the antagonists to that form of the disease, wherein the above are given, consist of ammonia, potass, and soda. The great object, however, is to balance the health, to allay irritation, and tranquillize the morbid uproar of the system. Here we have an extensive field to select from in the class of sedatives. Opium, perhaps, is the best—the most to be depended upon, its properties being best known; the warm bath comes next; and lastly, the various tonics and astringents of our pharmacopœia, of which quinine, uva ursi, pareira brava, achillæ millefoliæ, buchu, &c., &c., stand foremost.
Although the lithic acid deposition is the most frequent, still, as the disease advances, there is a strong tendency to the formation of the alkaline; and as the remedies for the former are apt to accelerate the latter disorder, it is most important that the urine should undergo frequent examination to regulate the treatment. To recapitulate the substance of this article, it may be stated, that gravel is a disease, not dangerous in itself, but that it is always the forerunner, although not always productive, of stone;stone being formed by the collection and chymical union of the sand itself. This collection takes place in the kidney, the ureters (the vessels that convey the urine to the bladder), the bladder, and sometimes in the urethra. The stone so formed varies in its composition and size, and is one of the saddest ills that can befall human nature. Hence the importance of watching, and attending to every urinary disturbance, of which gravel forms a prominent feature, the treatment of which has been already stated; but which, as it involves more practised judgment than a non-professional invalid can be supposed to possess, had better be intrusted only to professional hands.
THE END.