Book 2
3
The formation of stones is a long process, the stoppage of them painful, for the passage of them is not easily accomplished; and in addition to these, the retention of urine is formidable. But if several small ones stop together in the passage, or a large one be impacted; and if these occur to both kidneys, so as to occasion retention of urine and distension of the parts, the patients die in a few days. Nature, therefore, did well in forming the cavity of the kidneys oblong, and of equal size with the ureters, and even a little larger, so that if a stone formed above, it might have a ready passage to the bladder. On this account, also, the stones have an oblong form, because, for the most part, they are consolidated in the ureters; and such in that place as are of unequal thickness are slender before, owing to the ureters being narrow, but thick behind, because the kidneys verge downwards. They are formed in the kidneys only, but when in a heated state; for the stones have no fixed place in the ureters, but the gravel floats downwards with the urine, and thus is both indicative of the affection, and furnishes the materiel of it. But if an unusually large one at any time be detained in the pelvis of the kidney, pains of the loins, about the regions of the psoœ, as far as the middle of the ribs, take place, and hence, in many cases, the pain leads to mistake, as if it proceeded from pleurisy; heaviness of the hips; painful flexion about the spine, so that they stoop forward with difficulty; very painful tormina; at the same time, the pains are heavy with a sense of twisting, for the intestine is convoluted. But if the urine be retained in large quantity, and with distension, the desire of making water resembles the pains of labour; they are troubled with flatulence, which cannot find vent; the fevers are pungent, and of a dry nature. Tongue parched; the belly, also, dried up; they are emaciated, and lose appetite; or if they take anything, they cannot readily swallow or digest it. But if the stone fall down into the ureters, there is shivering, as if from rigor, the sensation as if from the passing of a stone with violent exertion. And if it fall down into the bladder, there is an abundant evacuation of watery urine, flatulent discharges from the bowels, the stomach settled, eructations, rest from former illnesses; and sometimes blood is poured out along with the urine, from excoriation of the passage. Another painful operation is the passage through the member; for if the stone be larger than the urethra, it is detained for a long time, the bladder is filled behind, and the ischuria is very painful, for along with the bladder the ureters, also, are filled. The passage of crooked stones is most difficult, for I have seen hooked protuberances on certain of these concretions. But, for the most part, they are oblong, being formed according to the shape of the passages. In colour, some are white, clayey, as is mostly the case with children; others are yellow, and saffron-coloured in old persons, in whom the stones usually form in the kidneys, whereas in children it is rather in the bladder. The causes of the concretion are two-fold: in old persons, a cold body and thick blood. For cold concretes thick fluids more readily than heat, the proof of which is seen in the Thermal springs; for when congealed, the water gets concreted into a sort of chalk-stones. But in children, the copious recrement of the blood, being overheated, gives origin to their formation, like fire.
