THE CHEMICAL COMPOSITION AND MODE OF FORMATION OF RENAL CALCULI, AND THE METABOLISM OF CALCIUM IN GOUT AND ALLIED CONDITIONS: Abstract of a Hunterian Lecture Delivered at the Royal College of Surgeons of England, February, 1911
Authors: B. Moore
Journal: BMJ (1911)

THE BRIm73Hin this.In a few of my cases-there has been, as it were, a miniature attack of this kind before the formidable and final seizure has come; such are due, no doubt, to little leakings from a tiny rent, whose edges are presently torn widely asunder to give vent to the profuse bleeding which is taking place.It is, I think, quite impossible for any one now to mistake this clinical picture for .anyother; the correct diagnosis should always be easily possible.The crises that develop in the course of cholelithiasis are exceedingly few.In more than a thousand gall-stone cases I have only twice met with a sudden rupture of the gall bladder, only thrice with acute phlegmonous chole- cystitie, and only once with acute gangrene with perfora- tion of a common bile duct, which was completely occluded by a large stone.The attacks of hepatic colic, especially those which are due to the temporary impaction of a calculaus in the cystic duct, are terrific in severity, but they are not lethal; the agony is almost unendurable while it lasts, and the very extremity of endurance is reaohed, but the danger to life is Quite inconsiderable.The acute cholecystitis which results will almost without exception subside in the course of a few days, ao that a deliberate operation can then be undertaken with every circumstance of care.That which chiefly distinguishes a patient suffering the torture of colic, whether hepatic, renal, or intestinal, from one in whom the perforation of a hollow viscus has occurred, is his ceaseless agitation and unrest.The former patient tosses and throws himself about, writhes on the floor or the bed, doubles and twists himself in the constant effort to get ease; the latter at the moment of the catastrophe seems to be struck motionless, and for hours may be hardly able to breathe or stir.How- ever acute the torment of hepatic oolic there does not seem to be any rigidity of the abdomen except in the immediate region ot the gall bladder.All other parts are supple, and free from any tenderness.A rigor, or a brief shudder, with only a trivial increase of temperature, is seen not infrequently in cases of inoipient cholkoystitis.When perforation takes place the temperature always falls.In all my hospital experience I have only known one case of hepatic colic sent in as a case of perforated gastric ulcer, and in that case there was also a subacute pancreatitis, for when an operation was undertaken some days later recent evidences of fat necrosis were to be seen.These are the chief among the various and most serious forms of.calamity that occur in connexion with diseases of the abdominal viscera.Of all such it is true to say that they should rarely be allowed to occur.We are now able to recognize with rapidly increasing accaracy the correct interpretation of many symptoms formerly ascribed to " fuctional " causes.We are quickly being brought to realize that those recurring sy'mptoms formerly supposed to indicate some vice in the action, some change in the secretion, or some disorder in the sensation of an abdominal organ, are in reality due to a perceptible alteration in its structure, and that though medical treatment and con-