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violence of the operation, he was so fortunate as to void the calculus with his urine; it weighed eight grains. On the 28th he again suffered pain in the region of the kidneys, and voided much sand, composed of uric acid, with ammoniaco-magnesian phosphate. He now took three half pints of soda water daily, which materially increased the proportion of the triple phosphate, while that of uric acid was considerably diminished. Ten drops of muriatic acid were then taken three times a day in water. The red sand now began to re-appear, and on the 4th of February, he voided a very small uric calculus. The urine made after dinner contained more or less mucus streaked with blood, a symptom which was much aggravated by a slight excess in wine. On the 6th, he left London, and employed no medicine until the 12th, when he returned in consequence of having voided a large quantity of the white sand.

Having observed the efficacy of carbonic acid in preventing the deposition of the phosphates, and having found it less liable than any other acid to induce a return of the uric gravel and calculi, I now directed him to take half a pint of water highly impregnated with fixed air, four or five times a day, and to drink cyder instead of wine. On the 18th of February, his urine was less turbid than it had been for some months before, and on the 20th of March, having continued the use of carbonic acid, he had no remaining symptoms.*

* I have several times examined the urine, with a view to ascertain whether

any

of the acids which were exhibited, could be detected in that secretion ; but the results of such experiments are so much interfered with by the very compound nature of the urine, that I have not hitherto been able to draw any satisfactory conclusions respecting them.

In August his urine became again turbid, but by the use of vinegar and lemon juice at his meals, which acids, he now finds, have no tendency to induce a return of the red gravel, he succeeds in preventing this symptom.

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Case 2. On the 11th of October, 1812, the operation for stone in the bladder was performed upon a boy, eleven years of age, and four calculi were extracted, of which the largest was of the size of a small horse bean: they were each composed of a nucleus or centre of uric acid, upon which the ammoniaco-magnesian phosphate was deposited.

After the operation, the urine deposited a large quantity of white sediment, and some small pieces of red gravel were occasionally voided. He was now directed to take eight grains of citric acid dissolved in barley water, three times daily; under this treatment the sediment in the urine was considerably diminished, but did not wholly disappear. The dose of the acid was gradually increased to twenty grains, by which means the sediment was only occasionally deposited, and consisted of little else than mucus. It was observed, that whenever the citric acid was omitted, even for twenty-four hours, the sediment was greatly increased, and this was constantly attended with frequent desire to make water, and other symptoms of irritation in the bladder. On resuming the use of the citric acid, the sediment always disappeared, and the irritation of the bladder subsided, and this happened so frequently, that no doubt could be entertained of the influence of the medicine on the composition of the urine.

This plan of treatment was continued for three months; at the end of that period, it was found that the urine had not the

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same disposition to deposit the phosphates as formerly; even when the medicine was omitted, the sediment was small in quantity, and not constant in its appearance. He was now directed to omit the use of the citric acid, and occasionally to eat oranges and other acid fruits. He continued this plan until the beginning of April, 1813; his urine was then quite clear, and he had no symptoms of disease.

Case

3.

In the month of October, 1811, a gentleman, thirtyfour years of age,

informed

me,

that he had observed a white deposit in his urine, during the whole of the preceding summer. He had taken considerable quantities of soda water, which he thought increased the sediment, and alkalies in any

other form produced a very obvious aggravation of the complaint.

His urine was at all times clear when voided; but after a few hours, a white powder was observed to separate from it, and a film of crystalline matter formed upon the surface. The former consisted of phosphate of lime and mucus, the latter of the ammoniaco-magnesian phosphate.

He was directed to take one drachm of muriatic acid properly diluted, at divided doses, during the day; and it was proposed that he should pursue this plan for a week ; but it

( was discontinued on the third day on account of its acting upon the bowels, and producing a frequent desire to make

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water. *

On the 10th of October, he was advised to take two large glasses of lemonade daily, and to substitute claret for port wine, a pint of which he was in the habit of drinking daily.

• In this and other instances the sulphuric and nitric acids were occasionally substituted for the muriatic; but they were found equally inadmissible,

Under this treatment the symptoms produced by the muriatic acid subsided; but the appearance of the urine was not at first improved.

On the 20th, the film of triple phosphate formerly constantly observed in the urine began to decrease, but the white sand remained as abundant as before; he was therefore directed to take twenty grains of citric acid twice a day, and to continue the use of acid drink, as formerly.

The additional acid at first disagreed with the bowels; but this effect soon ceased, and the sediment was only observed in the urine voided in the morning; he therefore took another dose of the acid every night. This plan was pursued with little intermission until the beginning of December: the deposition of the phosphates gradually ceased, and he remained in perfect health until the middle of May, 1812, when after violent exercise and taking more wine than usual, the white sand again made its appearance in great abundance; his stomach became extremely irritable, and the acids, which he had before employed with success, brought on considerable irritation in the bladder. The addition of ten drops of laudanum to each dose of the citric acid prevented this effect, and he was thus enabled to continue the acid, which in a fortnight relieved his complaint.

This gentleman informed me, that whenever he omitted the use of an acid diet, or took much wine, especially port, his urine deposited the white sand and mucus, for two or three successive days.

Case

4 A gentleman, eighty years of age, who had twice submitted to the operation for the stone within five years,

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voided with his urine considerable quantities of white sand and mucus.

From the age of this patient, and the account of his case, there appeared little doubt that the calculi had been formed in consequence of a diseased prostate gland, in the manner described by Sir EVERARD HOME,* and on examining them, they were found to contain no uric nucleus, nor indeed had there been any symptoms of disease in the kidneys, at any previous period.

This gentleman had been in the habit of taking soda water, from which he was now desired to abstain, with a view of putting him upon the acid plan of treatment. He was ordered to take eight drops of muriatic acid three times a day in two table-spoonsfull of water; but the third dose produced so much irritation in the bladder, and consequent increase of his symptoms, that it became necessary to adopt another treatment.

Lemon juice, or a solution of the pure citric acid, when given in quantity sufficient to produce any change in the appearance of the urine, had the same effect as the muriatic acid.

As water impregnated with carbonic acid could not be procured, he was directed to dissolve, in separate portions of water, twenty grains of citric acid, and thirty grains of the crystallised carbonate of potash, and to take the mixed solutions, during the effervescence. This quantity was at first only taken night and morning, but as it agreed perfectly well, it. was afterwards repeated four and five times daily. Under these circumstances the appearance of the urine was soon improved, and both the mucus and the sand were considerably

* Practical Observations on the Treatment of Diseases of the Prostate Gland, p. 39.

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