In the same way the extreme hardness of the water in certain districts must be looked upon as contributing to the concentration of the urine and correspondingly to the production of stone. The carbonates, sulphates, etc., of lime and magnesia taken in the water must be again thrown out, and just in proportion as these add to the solids of the urine they dispose it to precipitate its least soluble constituents. Thus the horse is very subject to calculi on certain limestone soils, as over the calcareous formations of central and western New York, Pennsylvania, and Ohio, in America; of Norfolk, Suffolk, Derbyshire, Shropshire, and Gloucestershire, in England; of Poitou and Landes, in France; and Munich, in Bavaria.
The saturation of the urine from any or all of these conditions can only be looked on as an auxiliary cause, however, and not as in itself an efficient one, except on the rarest occasions. For a more direct and immediate cause we must look to the organic matter which forms a large proportion of all urinary calculi. This consists of mucus, albumen, pus, hyaline casts of the uriniferous tubes, epithelial cells, blood, etc., mainly agents that belong to the class of colloid or noncrystalline bodies. A horse may live for months and years with the urine habitually of a high density and having the mineral constituents in excess without the formation of stone or gravel; again, one with dilute urine of low specific gravity will have a calculus.
Rainey, Ord, and others furnish the explanation. They not only show that a colloid body, like mucus, albumen, pus, or blood, determined the precipitation or the crystalline salts in the solution, but they determined the precipitation in the form of globules, or spheres, capable of developing by further deposits into calculi. Heat intensifies this action of the colloids, and a colloid in a state of decomposition is specially active. The presence, therefore, of developing fungi and bacteria must be looked upon as active factors in causing calculi.
In looking, therefore, for the immediate causes of calculi we must consider especially all those conditions which determine the presence of albumen, blood, and excess of mucus, pus, etc., in the urine. Thus diseases of distant organs leading to albuminuria, diseases of the kidneys and urinary passages causing the escape of blood or the formation of mucus or pus, become direct causes of calculi. Foreign bodies of all kinds in the bladder or kidney have long been known as determining causes of calculi and as forming the central nucleus. This is now explained by the fact that these bodies are liable to carry bacteria into the passages and thus determine decomposition, and they are further liable to irritate the mucous membrane and become enveloped in a coating of mucus, pus, and perhaps blood.