A XA N T H I C OXIDE CALCULUS From the Kidney. BY €OMJPJLIMMWTB OF The Author. GEO. L. PORTER, M. D., Of Bridgeport, Conn. EEPEINT EEOM New England Medical Monthly, MAY, 1881. THIS PAPE R WAS PUBLISHED IN THE It etc Ireland Medical Maathly:, A FIFTY-PAGE MONTHLY JOURNAL, DEVOTED TO MEDICINE AND SURGERY. EDITED BT WILLIAM C. WILE, M. D., PRESIDENT OF THE FAIRFIELD COUNTY MEDICAL SOCIETY. Published at Newtown, Fairfield County, Conn. Subscription Price;— Two Dollars per Annum, in Advance. The OTTT T MEDIC AT TO UHOT AT printed east of JSTew YorT City, save one. All communications should be addressed to the Editor, WILLIAM 0. WILE, M. D., Sandy Hook, Conn. A XANTHIO OXIDE CALCULUS FROM THE KIDNEY. made by Dr. Wriglit with quite uniform results. December 6th, 1880,—after stand- ing six hours, specific gravity 1012; reac- tion, acid ; color, pale yellow ; faint trace of albumen; sediment,white and flocculent. Microscope shows pus corpuscles, and oc- casionally an epithelial cell from bladder. (Pus coheres in masses but does not adhere to side of vessel). BY GEO. L. PORTER, M. D., OF BRIDGE- POET, CONN. THE patient was a young lady of eigh- teen, in manner refined, in temper serene, in disposition gentle. Never robust, at times she had suffered from transient pains in the back, yet had been in fair health until she was seventeen, when she lost strength so rapidly, that, unable to endure the work of the school room, she had interested herself in household affairs and enjoyed the society of many friends. The father, a studious clergyman, of un- usual intellectual ability, of good consti- tutional powers, had in 1875 and 1881 two severe attacks of nephralgia; the mother has been of delicate health from her youth ; the daughter was a blonde, tall, thin, anaemic. From early life she has had occasional local pains, severe but of brief duration, which were not satisfac- torily accounted for; during 1880 had several violent paroxysms in left lumbar region—a very severe one after salt water bathing. In August, 1880, as Miss B. was losing ground, without any recognized or- ganic trouble, but with increasing lassitude and failing strength, she visited friends in England; Sept. 12th, a week after land- ing, she was seized with severe pain in left kidney and was seriously ill for ten days. During this time there wras exten- sive hemorrhage, supposed to be from the kidney, and much pus mixed with, the urine. She was attended by W. S. Eccles, M. D., who thought the discharge proceed- ed from an abscess in the kidney, caused by a renal calculus. December 16th.—Specific gravity 1024; cloudy urine; pus corpuscles not quite so abundant. During January and February, 1881, had two attacks similar to the one in England, but not nearly as severe. March 14 and 15, had nausea, restless- ness, fever, severe pain over left kidney, only relieved by strong hypodermic doses of morphine, and retention of urine which required catheterization. LTpon the night of the 15th there was marked relief. Ex- amination of urine the next morning found specific gravity 1012 ; white turbid appear- ance ; microscope revealed a much larger number of pus corpuscles than usual, with very many peculiar nucleated oval bodies, “ granular exudation corpuscles,” # and considerable albumen. March 19th.—Specific gravity 1020; albumen less; smaller number of pus cor- puscles and none of the oval bodies. From this time the character of the urine improved but it was never entirely free from pus corpuscles. The general health was much better. During the summer spent some time at Dryden, N. Y., where she had one severe attack lasting however but a short time; no microscopical exami- nation w7as then made. She gained in flesh, strength and color, but would occa- sionally have a feeling of weight, some- times even a dull pain, over left kidney, and could endure no prolonged exertion. She returned to Bridgeport, Conn., in November, 1880, and since then has been under the care of Dr. Robert Hubbard and myself. She was not confined to the house, although she still had tenderness, and frequent pain in the left lumbar re- gion and general debility. There was no return of these attacks until October 16th, and then the attack was not especially painful, not the severe agonizing suffering of the attack in Eng- land, and of the three or four of the pre- vious winter. From this one, however, Regular examinations of the urine were * Basham on Kidney, Plate x, page 219. 4 there was no complete relief, but for three weeks there was constant uneasiness, ten- derness upon the loft side, dull pain, dis- tress. She graphically expresses her con- dition : u From the 16th of October, I was very miserable; my left side about the hip was drawn down so that I was quite de- formed and was lame; during this period every time that I coughed, or gaped I ex- perienced a sharp pain through my kidney, and almost constantly a dull ache.” tlxe apex and circling the stone, reached the plane of the surface nearer the base. The stone was carefully divided near G H by a lapidary, but was so frangible that the outer layers of each half were considerably broken. A cut is here given : On the 11th of November there was a sudden and complete relief of all of these symptoms, and as it seemed to date from an unusual discharge from the bladder, and as the vessel used at night had been immediately emptied, it was thought that a small calculus might then have passed. In the course of a week the usual symp- toms of stone in the bladder were reported and upon the 19th an exploration was made. No stone was felt and the exami- nation was not persevered in; but the urethra was partially dilated. During the early morning of the 22nd she “ had two attacks of intense irritation and pain at the neck of the bladder, one of which was just before the final release. The act of pass- ing the stone was absolutely painless.” In a few days the bladder was free from any symptom of irritation, and has so remained. Upon December Ist, 1881, the urine was of specific gravity, 1015; reaction, acid; color, light yellow; no albumen ; no pus ; slight mucous sediment. Diameter. In’s. Centime’s. Circum. In’s. Centime’s. A B 0.96 2.438 A B 2.40 6.096 C D 0.51 1.295 C 1) 1.55 3.937 E F 0.45 1.143 E F 1.45 3.683 G H 1.50 3.810 The structure was dense, hard and brit- tle ; the fractures were irregular; the cut surface assumes a waxy lustre when pol- ished, and also discloses a nucleus with dark brown border, irregularly oval, with a lighter laminated centre, and from the nucleus to the circumference concentric rings of gray and light brown laminae, so extremely thin that under the magnifying glass more than fifty layers were counted. The calculus is believed to have formed slowly in the kidney, either occupying one of the Pyramids of Malpighi, whose tubu- lar or medullary portion was gradually broken down forming a chronic abscess; or that forming in one of the depressions of the calyces the nucleus and the apex re- mained little changed, while the base was gradually increased by deposits, from the urine.* The former theory of location has most probability. The zone was evident- ly moulded by some constriction of tissue. The calculus weighed (3.1109 gram.) forty-eight (48) grains. The color was quite uniformly, a light shade of cinnamon brown. The surface was regular, hard, smooth but not polished. The shape was conico-cylindrical, compressed slightly so that a transverse section would not give the outline of a perfect circle ; the base, a segment of a sphere, regular and blunt; the apex terminated in a scalene cone with a sharp point; the cylindrical body was zoned with a slight depression near the middle, not at right angles with the long diameter, but commencing towards * The triple phosphate of ammonia and mag- nesia is rarely deposited in the kidney, but it may form a coating for the other calculi, if lodged for a considerable time in the organ.— Keyes.—Holmes' Surgery, Vol. IT, P. 823. 5 The belief that it is a renal calculus is founded upon the results of the chemical and microscopical examination of the urine; upon the long continuance of pain in left lumbar region; upon the absence in the early history of any prominent symp- toms of bladder irritation ; upon the sharp, almost needle point of the apex, which would not have formed in the free cavity of the bladder, and upon the characteristic discharge, in England, of hemorrhagic urine loaded with pus, following sudden relief of lumbar distress. Certain it is that the pain gradully de- parted from the lumbar region, and shift- ed to the hip and thigh, to the anatom- ical points supplied by the external cutaneous branch of the lumbar plexus, and to the region of the left ureter; that the action of the left psoas was hampered ; that there was sudden and complete relief, followed in a week by new and unmistak- able signs of interference with the escape of urine from the bladder. Generally the passage of gravel causes the characteristic pain of nephritic colic : that of a calculus, requires anodynes and anaesthetics*; but not always.t This stone did not pass with- out pain, yet did not occasion the usual agony; but it did cause, either b}*- pres- sure upon the psoas muscle, or by irri- tating the kidney and upper part of the ureter with the confined urine, the usual symptoms of calculous pyelitis, “lumbar pains sometimes dull and continuous, sometimes pungent and darting; often extended to and becoming fixed at the crest of the ilium, or prolonged to the outside of the thigh, with numbness or some altered sensation in the course of the external crural cutaneous nerve.”—Basham, p. 266. Notwithstanding the opening of the ab- scess, the stone probably remained in situ, acting as a local irritant until October 16th; at times, perhaps, with but a small drainage exit, through which the pus might ooze, and again at the time of the more serious attacks, rupturing the mouth of the sac, giving free escape to its con- tents. The attack of the 16th was occa- sioned by the bursting of the abscess and release of the calculus, which, free in the infundibula, was washed into the ureter, its transverse diameter conforming to the calibre of the canal; the apex towards the bladder. Filling, if not entirely obstruc- ting the ureter, the apex acted as a wedge; the depressed zone tending to give to the calculus a constant revolution upon its long axis, and the blunt base receiving the pressure of water behind, each part contributing the conditions best calculated to assist progression. The tone of the fibrous and muscular coats was lowered by the same causes, which produced the gen- eral lassitude, and slowly yielding to the gentle, constant and most favorably applied mechanical pressure—for the firm stone would hold every position gained by the in- sinuating water—the ureter might in this way give passage to the calculus with less pain than in any other circumstances.* In cases cited, Basham (Diseases of Kid- ney, p. 276-285) directs attention to the diagnostic importance of the statement of patient that “ she had frequently experi- enced an aching pain at the crest of the ilium of that side, with a feeling of numb- ness extending down the thigh.” Sir Ast- ley Cooper (Sam. Cooper's Surg. Diet., p. 1341 ) met with a case in which the chief * The amount of pain varies according to the magnitude of the stone and its character.”— DaCosta Med. Diag., p. 592. t “A small smooth stone may glide down the Ureter imperceptibly.”—Miller's Surgery, p. 420. •“ A small smooth calculus usually causes little inconvenience.”—Gross, Vol. 11. p. 652. “If the calculus be smooth and small, its passage down the ureter excites little or no in- convenience.”—Coulson, p. 243. “The calculus, if not too large, passes down the ureter into the bladder, with, in some cases, well marked symptoms of an aggravated colic ; in others this is not so apparent.”—Basham, p. 294. * ‘ ‘ But what is very remarkable, between the hypertrophied columns, pouches or sacs gener- ally coexist with dilated ureters, both states be- ing produced by the same physical cause. These pouches often contain calculous concretions. In extreme cases * * the Ureters * * are both dilated and tortuous.”—Coulson, p. 88. 6 pain was at the ant. sup. spinous process of the ilium. If the calculus passes through the ureter “it is of course small.” (Dorsey, vol. 11, p. 171 :) “the generality of Cal- culi, however, which leave the kidney are of small size.” (Cooper’s Surg. Diet., p. 1341): and as to location of cause of pain, “ Sir Astley Cooper has remarked, it is at the period when the calculus is passing over the lumbar plexus, that a great deal of pain is felt in the groin and in the course of the anterior crural nerve.” If this calculus had been small, there would be no hesitancy in accepting the theory of its origin and descent, but the successful termination of the passage and the com- parative freedom from the excessive pain of nephritic colic is remarkable, consider- ing the size of the calculus, which is among the largest, if not the largest that have successfully passed through the ure- ter. Carbonates of Lime and Magnesia traces Moisture, Xanthic Oxide. Chemical reactions. Heated before the blowpipe it blackened, and flew to pieces, and gave off an odor not unlike burnt lime and left considerable ash. Heated in a glass tube sealed at one end, it gave off’drops of liquid, of an alkaline reaction and contained carb. ammonia. The cal- culus dissolved in strong hydrochloric acid. When treated with strong nitric acid it dissolved, and left on evaporation to dryness, a lemon 37e110w residue, A por- tion of the calculus was dissolved in solu- tion of potash, filtered, and submitted to a stream of carbonic acid gas. A white pre- cipitate was pro luced, which after washing, and drying, was yellowish, and gave a waxy look by friction. Dissolved in nitric acid, the solution evaporated to dryness, water added, and then potash, it became of a bright red color. Dilute sulphuric acid caused a faint effervescence from which I inferred the presence of carbon- ates. The remaining portion of the fragments of the calculus was dissolved in nitric acid, evaporated to dryness, the yellowish resid- uum ground in an agate mortar, with caus- tic ammonia, the mixture thrown upon a filter, the liquid which passed through was of a bright yellowish color, and contained Xanthic Oxide in solution. The matter remaining upon the filter, was washed with distilled water and found to be phosphate of lime and magnesia. The precipitate produced by carbonic acid did not appear to dissolve in alcohol or ether. Dr. Macgregor (Amer. Jour. Med. Sci., January, 1877, p. 120) reports a very in- teresting case where a calculus cairn was found in the kidney of a woman who had “voided by the ureter upwards of three hundred calculi from the size of a shot (?) to that of a large bean.” (?) Larger stones have escaped by the open- ing of a renal abscess and have also been found by post mortem examination im- pacted in the ureter, in the infundibula, or occupying the cavity of'a sacciform kidney. The amount of calculus was too small to admit of an ultimate analysis. From its clinical history the calculus seemed worthy of honorable mention, but suddenly claimed intrinsic importance from the rarity of its chemical composi- tion. Submitted to State Chemist, S. P. Wheeler, for examination, after an ex- haustive investigation, it was pronounced a Xanthic Oxide Calculus, and the char- acteristic yellow precipitate returned. Respectfully yours, S. P. Wheeler, State Chemist of Conn. The presence of xanthine was conclu- sively demonstrated, but, that it might be corroboratively established by another in- dependent examination, it was submitted to Dr. Heineman, who wrote under date of March 24, 1882, the “calculus is a xan- thine calculus, and I have examined it with much interest and care.” April 12, 1882, “ I send you report and have only this to add that each test, as is my habit in doubtful or interesting cases, was repeated two or three and even more times.” The Dr. Gr. L. Porter : Dear Sir.—The Calculus handed me for examination consists of Phosphate of Lime, Phosphate of Magnesia, 7 full report of his very careful and satisfac- tory investigation is as follows : This is the eighth xanthine calculus on record ; is thought to be a better specimen than the three fragments in the British museums : is the only one ever recognized in this country; is the only one with a detailed clinical and personal history, and the only one, of which there is presump- tive evidence that it was wholly formed in the kidney. u The calculus consists of xanthic oxide or xanthine, a large quantity of calcic phosphate, some ammonio-rnagnesian phos- phate, traces of uric acid and calcic oxa- late. The diagnosis of xanthic oxide or xan- thine was based upon : I.— General appearance of Calculus. Ist. Uniform reddish cinnamon color. 2d. Its compact texture and peculiar lamination, 3d. Its waxy lustre upon friction. Xanthic oxide, whose chemical formula is Cio EU X 4 04 (Gmelin, Hand’d Organ. Chem. Vol. X., p. 454.) “ would be the mo- no-basic acid of the radicle whose hi basic acid is uric acid,” is thought to be caused by some arrest in the process, which ulti- mately forms uric acid, and is found : ll.—Beaction to Blow-pipe. Crackled, split up into small pieces, which turned bluish black, and finally leaving a bluish white ash. Emitting a peculiar nitrogenous odor, accompanied by abundant fumes, which turned red litmus paper blue. I. In the tissues and fluids of animal bodies. 11. In Jarvis guano; and 111. In urinary calculi. It has been found : 111.—Chemical Beaction. Ist. Feebly soluble in hot water, im- parting1 acid reaction. 2d. Dissolved in nitric acid, and beat- ing in a porcelain capsule a lemon yellow residue was obtained, which became yel- lowish red on the addition of potassic hydrate and reddish on further heating. 3d. Soluble in alkalies. 4th. Soluble in strong hot hydrochloric acid. I.—lst. In the blood: H. Andrea found xanthine and hypo-xanthine in the blood of a chlorotic patient, (German Periodical Prac. of Med., 1875, No. 29). 2d. In the muscles : Demant found xan- thine and hypo-xanthine in equal propor- tions in the muscles of famished doves, but failed to discover them in those of the well nourished. IV.—Microscopic Fxamination. Narrow elongated prismatic crystals of chloride of xanthine, obtained from solution in strong hydrochloric acid. 3d. In the brain: by Prof. Scherer, [Ann. Ch. Pharm., CVII. p. 314); by Stadeler, [Ann. Ch. Pharm. CXYI. p. 102). The presence of urate of ammonia, per- haps, could not have accounted for the abundant alkaline fumes, since the un- mixed test gave only the slightest indica- tion of the presence of uric acid or its compounds. Nor was there sufficient calcic oxalate or uric acid in the small and particular portions of the calculus used, to account for the decided acid reaction. 4th, In the pancreas : Scherer [Ann. Ch. Pharm., CV. p. 314; CXII. p. 276.) sth. In the liver: found in the liver of oxen, and in the acute yellow atrophy of liver in man, Scherer [Ann. Ch. Phar. CV. p. 314,) and Cloetta [Ann. Ch. Phar. XCIX. p. 289). (Signed) H. N. Heusteman, M. D., Instructor in Urinary Analysis in Laboratory of Alumni Associa- tion of College of Physicians and Surgeons, New York.” 6th. In the thymous gland : Gorup, Besanez, Scherer, Frerichs and Stadeler, [Ann. Ch. Pharm. CY. p. 314). I desire to thank these gentlemen, not only for the care and skill of the examina- tion, but for the professional interest shown in not injuring the contour of the specimens. 7th. In the spleen: first found by Scherer, [Ann. Ch. Phar. CVII. p. 314); afterwards recognized by Stadeler, [Ann. Ch. Pharm. OXVI. p. 102) and Neubauer, [Jour. Analyt. Chem. Vol. 6, p. 33, 1867.) 8 Bth. In the urine : discovered in normal urine by Scherer, [Ann. Ch. Pharm. OVII. p. 315), Weiske observed a sediment of xanthine in the urine of a chlorotic ram ; (?) after allowing the urine to stand four or five days, there wras only uric acid to be found in the sediment, [Jour, of Biology, Vol. 11. p. 254, 1875). Harley states that “ Maclagan [Edin. Med. Jour. 1851) be- lieves he found it in the urine of an hysteri- cal girl, and Jackson, [Arch. d. Pharm., 1837,) thinks he met with it in a case of diabetes. Bence Jones, [Jour. Chem. Soc., 1862,) has lately described a case in which a crystaline deposit of xanthine repeatedly appeared in the urine.” By consulting Har- ley, [Urine and its Derangements, p. 201) the microscopic appearance of the sponta- neous deposit of xanthine, and its crystal- ization with hydrocloric acid may be seen. compact, hard and laminated, surface smooth. It is of a reddish cinnamon color. Between the red laminae faint whitish lines are perceived. When the blow-pipe is ap- plied it crackles, splits into small pieces. * * The smell it emits is that of an animal substance and is peculiar. * * * It does not at all resemble that of the lithic acid or of the cystic oxide. When ex- posed to destructive distillation it crackles, splits into scaly fragments, blackens and emits a foetid ainrnoniacal liquor, from which carbonat of ammonia crystalizes in cooling, and a heavy yellowish oil. * * * Caustic potash dissolves this calculus very readily. * * * \yiien the solu- tion of the new substance in nitric acid is evaporated to dryness the residue assumes a bright lemon color. This yellow resi- due is partly soluble in water to which it communicates its color. The addition of an acid takes away the yellowness, but if caustic potash be added to the yellow sub- stance, it instantly turns it to a more or less intense red color, according to the de- gree of dilution, and upon evaporation it assumes a brilliant crimson hue, which however disappears on adding water, the yellow color being reproduced and remain- ing perfectly transparent. The previous action of nitric acid is necessary for these singular changes. * * It is insoluble in alcohol or ether, * * sparingly soluble in acetic acid, * * insoluble, or nearly so, in oxalic acid, or bicarbonat of potash, or saturated carbonat of ammonia.” ll.—Xanthine may be obtained from Jarvis guano by the action of nitrous acid, [Watt's Chemistry, Vol. Y. p. 1050). lll.—Urinary Calculus. The extreme rarity of the xanthine calculus is evident from the fact that only seven previous cases have been recorded: Ist, by Marcet ; 2d, by Langenbeck; 3d, Tangier; 4th, Hulk,* sth, Coles: Cooper: Taylor; 6th, Fleming ; 7th, Gaillard. . It is impossible in our medical libraries to obtain all of the references. They are not to be found in New York, and Dr. Billings writes me from the Surgeon Gen- eral’s office, that “ about one-half only of the books to which you wish reference are in the library.” To give a satisfac- tory description of these calculi, I have freely quoted their history, and, where original journals could not be obtained, have used other journals referring to them. The examination and report exhibit an intelligent, systematic and exhaustive in- vestigation, and the original description of a xanthine calculus by Marcet is the classical standard. The lack of material prevented other experiments, and explains the fact noted by Mr. Taylor, that “ no trace of the original calculus discovered by Marcet can now (1868) be found.” Coulson [Dis. of Bladder, London, p. 327) erroneously gives the weight of this calcu- lus as eight ounces, instead of eight grains. If Marcet accomplished so much with Ist. Marcet, [Chem. History and Med. Treatment of Calculus Disorders, London, 2ded. 1819, p. IGSetal.) Before 1817, Dr. Babington, of London, gave to Dr. Alex- ander Marcet, for examination, a number of calculi, among them one whose weight was only eight (8) grains, and was “of an oblong spheroidal shape. The texture is 9 eight grains, what a quarry for original investigation would eight ounces have pre- sented ! As soon as Marcet recognized the new chemical elements of the calculus, he communicated with his friend, and re- quested its clinical history, but Dr, Bab- ington could not recall, either the name of the patient who furnished the stone, or any other fact concerning it. The statement by Stadeler [Ann. Ch. Pharm. CXI. p. 28) that “this stone was found * * by Babington in the urinary bladder of a boy” is gratuitously inaccurate. Marcet dubbed the new substance xanthine or xanthic oxide, because of its characteristic yellow color, and not because of its chemical significance, for it is a Uric Oxide. Harley, p. 201, states generally that “ the stone broke in process of extraction, and these portions were presented by Langenbeck to our late Professor of Sur- gery, Mr. Liston,” while another more definite account relates that “ Prof. Merz, of Gottengen, sent the fragments of the calculus to Dr. Willis, one of which is in the museum of the Royal College of Sur- geons, Edinburgh, and the other is in the Guy Hospital Museum.” A ohrorao-litho- graphic representation of the fragment in the Royal College Museum is shown in Plate XIII, Dr. Keyes, Holmes Surg., Vol. 11., p. 828. 3d. Latjgier’s.—Some minute speci- mens, “ globular, smooth, and of dark brownish yellow color,” containing xan- thine have been reported by Laugier, [Jour, de CJiem. Med., V. p. 513) but no fragments remain. “ Laugier has also examined a xanthic oxide stone.” (Che- Hus' Surgery, Vol. 11. p. 246). 2nd. Langeebeck's.—Removed by this surgeon from the bladder of a Hanovarian peasant boy eight years old; was next to the largest xanthine calculus and weighed “ six drachms and a half,” Gross. Yol. 11., p, 707; “339 English grains,” Holmes Surg., Vol. 11., p, 829; “338 grains,” Coulson, p. 207; “ was the size of a pigeon’s egg and may have weighed 18 to 20 grams,” (Ann. Chem. Pharm. Liebig, XXYI. p. 341). During the operation it was broken into three pieces ; the frag- ments disclosed concentric laminae of brown and light brown shades; the faces being rubbed, assumed the peculiar waxy gloss, and there was a distinct, but chemi- cally homogeneous, nucleus. In this stone xanthine was re-discovered by Stroraeyer (Ann. du Physic., B. 41, p. 393) found by Prof. Scherer (Ann. Ch. Phar., CV. p. 314), found also by Wohler and Liebig, (Ann. Ch. Phar., XXVI. p. 341) and an- alyzed for the first time by them, (Hand'd Organ Chem., Yol. X., p. 454, et ah). 4th. Dulk’s.—“Another Calculus is mentioned by Dulk,” (Coulson, p. 207) but I have only found this single state- ment regarding it given without reference. sth. Coles: Cooper: Taylor.—The chemical composition of this specimen was discovered by Mr. Thomas Taylor in 1866, and made the subject of a special report to the Pathological Society in 1868. Briefly, “ owing to small size of calculus, and its great rarity, I did not feel justified in sub- mitting it to further chemical examination than was sufficient to identify it. This cal- culus of which the college (Royal College of Surgeons, England,) possesses one-half, the other being probably (?) in the museum of Guy’s Hospital, was presented to the college in 1851 by the late Mr. Bransby Cooper * * * to whom it had been given by Mr. Geo. Coles, a surgeon in the service of the East India Company; it was extracted by him from the bladder of a Mussulman child, aged four years.” The memorandum, with the stone, stated : “or- dinary symptoms; calculus easily detected; operation lasted twenty minutes"; des- The results of their analyses are shown in the accompanying table. Dried at 100° Wohler. Liebig-. 10 C 60 39.48 39.86 4 N 56 36.85 36.72 4 H 4 2.63 2.60 4 0 32 21.05 20.82 Cio N4 H4 O4 152 100.00 100.00 10 cribed by Cooper, {Guy's Hospital Deports 1851) as consisting of a peculiar red tinted uric acid, mixed with urate of ammonia, and containing layers of oxalate of lime, with traces of earthy phosphates.” JVIr. Taylor, however found that it consisted of nearly pure xanthine, and the general ap- pearance and structure closely resembled the description given of the calculi by their discoverer, the late Dr. Marcet. When entire it weighed ninety grains ; it is made up of three concentric layers, closely aggregated, sort that its cut surface presents a compact surface; it possesses the peculiar flesh, or reddish, cinnamon tint, which seems to be characteristic of these concretions. Its nucleus is how- ever of a yellow tint, but I could not de- tect the presence of uric acid in the nu- cleus. Since the discovery of this species of calculus in 1817, only two other speci- mens have been placed on record ; namely, that extracted by Prof. Langenbeck and the present specimen. The close similarity in composition, which exists between uric oxide (xanthine) and uric acid would lead to the conclusion that these substances might frequently be found mixed together in the same calculus, I have, however, submitted to careful examination several uric acid calculi, which from their exter- nal characters might be supposed to con- tain xanthine, but hitherto without suc- cess.”—Dath. Soc. Trans., XIX. p. 275. cuius, which he had previously seen, the gentleman gave it to me, and ashed if it could have escaped from his urethra with- out his knowledge. At the time he had no additional urinary distress, hut subse- quently he was free from his former sensa- tions, and has had no return of them since. This body on subsequent examination proved to be a xanthic oxide calculus. The examination was made by Dr. A. 11. Hassall, After recounting the usual tests he reports that the only particulars differ- ing from the recorded action of xanthine with reagents, were “ its solubility in hot alcohol, .and in the aqueous solution of the nitric acid residue furnishing, on evapora- tion, a brownish yellow, in place of a blood-red or carmine residue, as usually described. It,s solution in- caustic potash did yield, on evaporation to dryness, a product of a pink: or carmine color. The quantity of theymlculus now remaining is too small to allow of an ultimate analysis being made.” {Fleming's Injuries and Dis- eases of the Genito-Urinary Organs, 1877.) From this closing statement, and from the fact that its present location is not of record, I judge its value as a specimen was destroyed by the examination. 7th. Gaillaed’s.— Gazette Hebdoma- dairc, No. 16, April 18, 1873. Dr. Gail- lard removed by perineal section, from a boy of thirteen, a calculus which weighed 22.50 gram., (347.17 grains) and measured five (5) centimeters (about two (2) inches) in its longest diameter. 11 It had the ap- pearance of a sphere studded with large tubercles, which made it resemble one of those antique hatchets which are depicted upon the panoplies of our museums. Its color was brick-red, resembling that of old mahogany ■, it broke readily under strong pressure. The forceps employed in draw- ing it from the bladder, had torn the ex- tremity of its knops. Divided, this calcu- lus disclosed two pieces of a reddish brown, susceptible of a very fine polish, veined with concentric lines, which were quite regular towards the centre, but becoming 6th. Fleming’s.—About October 1864, “a gentleman of middle age, of full ath- letic frame, suffered for some time from irritability of bladder. At times there was interruption in the current of urine and the perineal discomfort was so great that he could not sit erect on a chair, but was obliged to place himself on its edge. One day in standing up from this position, he heard some solid material drop on the floor, and on searching for it, he found lying near his chair a small, brownish col- ored substance, about the size and shape of a garden pea. It was solid and rough, and from its resemblance to a urinary cal- 11 sinnons as they approached the periphery, and consequently indicating how this cal- culus, developing itself asymmetrically had acquired the irregular outline which it pre- sents.” Detailing the examination he con- cludes : u This calculus was therefore com- posed of xanthine, of which it presents all the reactions. The only regret is that a microscopical examination, and a quanti- tative analysis were not made in this case.” On account of this regret, of a statement regarding the analysis, “ its substance re- duced to powder”; of the fact that a pho- tograph, and not the stone itself, was shown with the report, and that no men- tion was made of present location or in- tended destination, I am inclined to think no specimen of this calculus remains. some relation to the yellow coloring clat- ter; by Durr, (Jdhresb. 1865, p. 675) that its presence in human urine—where ther 3 is naturally about grains in 600 pounds (Neubauer)—is promoted by the use of sulphur baths; by Thudicum, (p. 4) that the lemon yellow color (of urine) some times met with in cholera, or in spinal dis- ease, is due to the presence of an excess of uro-xanthine ; by Maclagan, Jackson and Bence Jones, before referred to, rela- ting respectively to its presence in hys- teria, diabetes, mollifies ossium ; of Vogel, (Harley, p. 200) that it is much increased in cases of enlarged spleen, and also in acute atrophy of liver, and of Wilson, (Dis. of Sldn, p. 606) regarding its pres- ence in the xanopathia, lentigo and chloasma. The yellow discoloration of skin by nitric acid might be caused by the xanthic element of the tissues. The clinical points regarding xanthine are the statements by Dunglison, [Med, Diet., p. 1079) that it is not discovered in healthy urine, although probably bearing N. B. A Tabular Recapitulation of all the recorded Xanthic Oxide Calculi will be found on the following page, folio 354. 12 Name 1. Marcet. 2. Langenbeck. 3. Laugier. 4. Bulk. 5. Coles: Taylor. 6. Fleming. 7. Gaillard. 8. Porter. Date 1817. About 1820. *No Record. No Record. 1 1S51. 1864. 1873. 1881. No record Weight 8 grs 0.319 gms. 338. grs .21.2509 gms. No record No record 90 grs 5.083 gms. No record 5 Centimeters 347.17 grs..22.50 gms. 3.934 Centimeters... 1.143 “ 48 grs 3.1109 gins. How Obtained No record Operation No record No record Operation Passed without pain. Operation Passed without pain. By whom examined. Present Location Marcet, Wollaston and Front. No record Stromeyer, Wohler & Liebig, Scherer and others. Fragments in Guy’s Hospital and Royal College of Surgeons, Edinburgh. Laugier. (?) No record Bulk (?) No record Taylor . Fragments in Royal College of Surgeons, England,and perhaps in Guy’s Hospital. Hassall & Grimshaw No record Gaillard (?) N o record Wheeler and Heine- nian One-half in United States Army Medical Museum, and one- half in Jefferson Col- lege Museum, t * No Eecord only means that I have found no record. That the two (Nos. 6 and 8,) xanthic oxide calculi, the only specimens which'passed naturally, occasioned in the urethra no pain, may be merely a coincidence, or may have clinical importance, if corroborated by future experience. t The specimens of this calculus are still in my possession, but will ultimately be given, one to the Army Medical Museum at Washington, and the other to the Museum of Jefferson Med- ical College, of Philadelphia, my Alma Mater, where I hope they maybe of use to many. Beidgepobt, Conn., April 29,1882. TABULAR RECAPITULATION. XANTHIC OXIDE CALCULI.