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obstruction moved forwards to within an inch of the extremity. of the urethra: it remained there till the following evening, when, by the help of a small pair of watchmaker's forceps, I succeeded in extracting a stone, which was the source of the mischief.
It was jagged and rough, and of a deep brick-red colour. I afterwards voided a considerable quantity of red crystalline sand.
My physician, who was apprehensive of a return of the disorder, desired me to purchase of Cadell, an anonymous pamphlet upon the Stone and Gravel, and to observe the rules there laid down. This treatise particularly recommended the use of the alkalies. I therefore took the lixiviuin, and two bottles of PERRY's solvent; but the red deposit in my urine continued, my loins felt weak, and when in bed very painful.
. Being in the profession of the law, and much employed, I was under the necessity of leading a very sedentary life, which so aggravated my tendency to bile and indigestion, that I seldom could get above two or three hours sleep.
With a view to alleviate these symptoms, and not with any idea of its being beneficial to the stone, I resorted to magnesia, which I continued with little intermission for eight months in the dose of a tea-spoonful or two, every evening before I went to bed. The long vacation coming on, I gradually took more exercise, and used the cold bath. The tone of my stomach, at the end of the period I have mentioned, was so far restored as to induce me to set medicine of all kinds aside, except when any food or drink disagrees, when I occasionally resort to the magnesia. Under such treatment, the weakness and pain in my kidney left me, and the red sand entirely disappeared. I
have since enjoyed a very good state of health, and am now in my fifty-seventh year.
If I occasionally make a little free with the good things of this world, my stomach reminds me of the improper use of the lixivium, especially when I am prevented taking my usual exercise.
The above case is important, not only as furnishing a striking and unprejudiced instance of the effect of magnesia, in counteracting the tendency to form uric calculi and gravel; but likewise, as demonstrating its efficacy where the alkalies had failed, and where the digestive organs had been injured in consequence of the use of such remedies: the time which has elapsed since the cure of this and other cases, without a relapse, is also strongly in favour of this mode of treat
Case 9. A gentleman twenty years of age who had suffered from heartburn, and other dyspeptic symptoms, was seized, on the 1st of June, 1811, with a violent pain in the loins, and more especially in the right kidney, and during the night he passed a large quantity of red sand with his urine. On the 2d, with a view to relieve the pain, which had increased considerably, he took fifty drops of laudanum, and drank freely of barley water. The night was passed more quietly, but on the morning of the 3d, he was seized with a violent pain in the kidney, and with the usual symptoms of the passage of a calculus along the ureter. These continued with more or less violence till the evening of the 4th, when he became perfectly easy, and remained so till the morning of the 6th, when, with
considerable pain and difficulty, he voided a calculus composed of uric acid, weighing nine grains. For several successive days his urine deposited a large quantity of red sand, and three very small round calculi were voided.
He was now directed to abstain from all kinds of fermented liquors and sour food, and to take a pint of treble soda water, (containing three drachms of sub-carbonate of soda,) daily. Under this treatment he continued to recover, and remained perfectly free from complaint until the end of August, when a copious deposit of red sand appeared in his urine: he had little pain in the affected kidney, but complained of almost constant nausea, or want of appetite. The soda water was increased to a pint and a half, and afterwards to two pints daily, and in the intervals he drank very freely of barley water.
Having persevered in this way for ten days without receiving any benefit, he was induced to make a trial of magnesia, of which he took one tea-spoonful night and morning in cold chamomile tea. In about a week, the state of his stomach was much improved, and the deposit in the urine proportionally diminished, and in three weeks every symptom of disease had disappeared.
In February, 1812, having persevered in the use of magnesia with little intermission, I was informed that the sand had returned, that increasing the quantity of magnesia had produced no good effect, and that alkalies materially aggravated his complaint, by disagreeing with the stomach and greatly increasing the urinary deposit.
On examining the sand, I found that instead of consisting as formerly of uric acid, it was composed of a mixture of the
ammoniaco-magnesian phosphate with phosphate of lime; he was directed to abstain from magnesia and alkalies, and to adopt a plan of treatment which it is the object of the second section of this paper more particularly to explain.
The foregoing is a well marked case of uric gravel with a strong tendency to form calculi, materially relieved by the use of alkaline remedies : it illustrates their usual effects when carelessly persevered in, and shews the advantage with which magnesia may in such instances be employed: it also exhibits the effect of magnesia and the alkalies, in producing the deposit of white sand (or phosphates) in the urine, when the red sand (or uric acid) has been removed.
The cases which follow are selected, from among others, to explain the best mode of preventing the formation of white sand, and to shew the most effectual treatment where it is a natural deposit in the urine, or where it has been induced by the incautious exhibition of alkaline medicines.
The white sand so frequently voided by persons labouring under calculous complaints, was first analyzed by Dr. WOLLASTON,* who found it composed of ammoniaco-magnesian phosphate, either alone or mixed with variable proportions of phosphate of lime. The use of acid medicines in these cases was also first suggested by the same able chemist, but although his valuable observations have been before the public for nearly fifteen years, I am not aware that any
* Phil. Trans. 1797
experiments have been made to ascertain what acids are best calculated to produce the desired effect, or to illustrate their mode of action.
Since my former communication, I have lost no opportunity of attending to this important subject, and hope that the conclusions, suggested by the following cases, will be deemed satisfactory, and that their application in practice may lead to useful results.
Case 1. A gentleman, fifty years of age, who about ten years before had undergone the operation for the stone,* was attacked on the 14th of January, 1810, with violent pain in the right kidney and ureter, which lasted two days; on the 17th, these symptoms subsided, and were followed by those of stone in the bladder, which continued for some days, and · although he had taken abundance of barley water and similar diluents, the stone shewed no disposition to pass. On account of his former sufferings, this circumstance rendered him extremely uneasy, and on the evening of the 21st, he suffered several severe paroxysms of pain on attempting to make water. Under these circumstances, he was desired to take a purge, composed of two ounces of infusion of senna, two drachms of tincture of senna, and twenty grains of powdered jalap.+ In three hours this began to take powerful effect, and during the
• The stone extracted consisted of a nucleus of uric acid about the size of a pea, incrusted with a mixture of the phosphates. It was broken during the operation, but appeared to have been of the size of a pigeon's egg.
+ I recommended this treatment in consequence of having heard Sir EVERARD Home state a case, in his Surgical Lectures, of a gentleman who suffered a bougie to pass so far into the urethra, that it could not be removed by any instrument. During the operation of a purge it was expelled with considerable force.