sometimes found in the liver, while taurine as well as cystine have been detected in the urine.

The proportion of cystine in urine is really very small, seldom amounting to more than two or three grains in 1000 of urine, although it occupies a considerable bulk; so that the opinion commonly entertained with reference to cystine being a compound in which the sulphur is removed from the organism in an unoxidized state, in consequence of the oxidizing processes being in a low condition, will not explain its formation, for in a case I carefully examined, it was found that a much larger quantity of sulphur passed off as sulphuric acid than in a state of combination in the form of cystine. Cystine has been met with in several different conditions of the system, but in most of the recorded cases the patients have been in a low, weak state of health. Little is known with reference to the origin of this substance. It has been supposed to result from hepatic derangement, and Scherer and Virchow have detected cystine in the liver in disease. It is curious that cystine deposits occur in families, and even appear to be hereditary. Dr. Golding Bird speaks of an instance of its occurrence in three successive generations. Of the conditions of system which give rise to the elimination of this substance by the kidneys, little is at present known. In the majority of cases in which it has been found, the general health and nutrition of the patient have been bad. It is one of the most persistent of urinary deposits. After it has once appeared it may be produced, and in considerable quantity, over a period of twenty years or more, or its`production may only cease with life. It is among the least common of urinary deposits, and usually its presence is not associated with any symptoms more serious or definite than malaise, a feeling of weakness, fatigue or exhaustion, with depressed or very low spirits.

One of the most remarkable cases of cystine deposit which I ever saw came under my notice many years ago, and has been under observation for fifteen years or more. During part of this time I saw the patient very frequently, and made many examinations of the urine of the deposit, and of the calculi, which he

passed in considerable numbers. This case and the following were reported in the Lancet, of August 30th, 1884.

The patient (E. H. O.) was a fairly healthy-looking man, of 30, 5 ft. 51⁄2 in. in height, weighing 9 st. 6 lbs., who was by trade a packer, an occupation involving pretty hard work and long hours. For four years before he came to me he had suffered more or less from lumbar pain and discomfort about the thighs, especially on exertion, and he often felt weak and low. He sometimes had to walk with a stick, and had had to give up work now and then for a week or two at a time. About two years after the first commencement of the symptoms he suffered from a fixed pain in the left groin, and soon afterward several stones were passed, sometimes to the number of twelve or more at once. One of the calculi, however, was so large that it remained in the bladder, and Mr. Coulson had to crush it.

I put the patient on carbonate of ammonia, and told him to increase the dose gradually until it amounted to about fifty grains a day. He found the remedy agree with him so well that he soon exceeded this quantity, and for twelve months he took as much as fifty-five grains daily on the average, on some days consuming much more, on others considerably less, than this amount. In this time he did not pass as many calculi as before he had passed in a single month, and his weight increased to 9 st. 11 lbs. In the next year he took about thirty-five grains of carbonate of ammonia per diem, and in the following only an average of about twenty grains a day. This patient's family history, was not very satisfactory. His mother died at the age of 52, of phthisis, and two sisters died under the age of 25, of the same disease. He did not look a strong man, and the muscles of his arms and legs were below the average size and prominence. When a young man he used to take violent exercise, and rowed in races. The quantity of urine passed was generally about the average, and never exceeded three pints. Every specimen that passed during a period extending over at least five years, he feels sure contained cystine. Afterward the cystine was very frequently detected in considerable quantity. The crystals could be seen in the urine immediately after it was passed, as small,

sparkling grains. The ammonia not only diminished the formation of the cystine, but the patient found that while he was taking it his bowels acted freely, and he never required an aperient, although previously he had been much troubled by obstinate constipation. When the ammonia was not taken he says he did not feel as well as when he was taking it. He found no inconvenience from taking these large doses of carbonate of ammonia, and soon became so accustomed to the taste that he did not object to it in the least. I have seen this patient at intervals during the last few years, and although cystine in small quantities was generally present in the urine, it gave him no inconvenience, and no calculi seem to have been formed for the last three or four years. In this case, then, cystine has been found in large or small quantity during a period of at least eighteen years, and for the first five or six years of this time hundreds of cystine calculi were passed, the largest being about three-eighths of an inch in diameter, the smallest not larger than the head of a very small pin. The cystine crystals formed a visible whitish deposit, which varied much in quantity, even from day to day, but sometimes formed a considerable sediment.

Another case was that of a gentleman, about 50, who had suffered from abundant cystine deposit for two years before I saw him, and had passed seven or eight renal calculi, some of them beautifully crystalline, and entirely composed of cystine. This patient took fifty grains of carbonate of ammonia dissolved in two ounces of distilled water three times a day, after a meal, for upward of two years, without any inconvenience, and during this time he had not even once required an aperient. If he gave up the ammonia he did not feel "up to the mark." As the amount of ammonia seemed very large in proportion to the water in which it was dissolved, I had twenty-five grains of Howard's volcanic carbonate of ammonia dissolved in an ounce of distilled water, and found that, although it tasted very strongly, it was not caustic. On inquiry, Mr. D― informed me it was only gradually that he reached this degree of concentration, but that he experienced no difficulty in taking it. He took it immediately after a meal-" on an empty stomach it produced nausea."

For three years, with scarcely an intermission, 1050 grains of carbonate of ammonia were taken per week. The cystine deposit ceased during the last year of taking the medicine, and three years have now passed without its recurrence. I think, therefore, we may regard this case as really "cured" by the large doses of carbonate of ammonia.

It is to be feared that the tendency in the present day is rather to prescribe new remedies which are being continually introduced, than to select old ones such as are known to have valuable properties, and which have been proved by long experience to be really beneficial in certain pathological conditions. Far from condemning the new because they are new, like all who know the extreme value of such things as salicylate of soda and bromide of potassium, I am most anxious to acknowledge my gratitude to those who devote themselves to the study and the discovery of the healing properties of every substance that can possibly be of use in treatment. But, while I am desirous not to say anything that could suggest to the reader that I am condemning the new things, I would impress upon the rising generation of practitioners the importance of being careful not to neglect the old. One cannot but desire that a drug like ammonia, so valuable in many forms of disease and departures from the healthy state, should not be forgotten or laid aside.*

The cases I have adduced are sufficient to show that ammonia

* In our endeavors to help those who have acquired the vicious habit of consuming too much alcohol, ammonia is of great use, but it ought to be given in doses far larger than those in which it is usually prescribed. One of my patients assured me that he found ammonia very beneficial; that it relieved him of the feeling of tiredness from which he frequently suffered, and enabled him to perform hard work without getting exhausted. Not only have I found great benefit result from giving ammonia in considerable doses in many low forms of illness, but I have experienced its good effects by taking it myself. It acts very differently from any form of alcohol, although its effect upon the patient, as judged from his own sensations, appears to be somewhat similar. Though no feeling of hilarity seems to be induced by it, the lowness and depression of spirits and the tired feeling affecting the muscles, or rather the nerves and nerve centres by which they are supplied, are often removed in the course of half an hour or less, by a dose of ammonia.

may be given in much larger doses than are generally prescribed, and that it need not be diluted to the degree generally supposed to be necessary. We used to be taught that five grains of carbonate of ammonia should be dissolved in at least an ounce of water, but as one of my patients took as much as twenty-five grains per ounce, and continued this three times a day for three years, we may feel satisfied that a solution of from ten to fifteen grains per ounce may be taken without difficulty, and I have prescribed this as often as once an hour in cases where the heart's action was very feeble and a decided stimulant was evidently necessary.

The public have discovered the value of sal volatile in cases of cold-catching and many minor ailments, but ammonia, like many other substances of real value in the treatment of many departures from the healthy state, has lately been somewhat neglected, and is, like some other valuable remedies, in danger of being forgotten amid the multitude of new preparations which are thrust upon our notice; and it is therefore desirable that attention should be directed to its usefulness as well as to the value of many other drugs which have been of real service to past generations of patients.

DEPOSITS OF EARTHY PHOSPHATES.

The earthy phosphates soluble in acids, but insoluble in water and alkaline solutions, which are most commonly met with as deposits in urine, are the ordinary triple or ammoniaco-magnesian phosphate, or the phosphate of ammonia and magnesia; and phosphate of lime. The triple phosphate crystallizes in two or three different forms ("100 Urinary Deposits, Pl. V, Figs. 56, 57, 58, 64, 66; Pl. VII, Fig. 91). When clear, and unmixed with other deposits, the crystals form beautiful microscopic objects. The most common form is that of the triangular prism, with obliquely truncated ends; but these are sometimes complicated by the beveling of the terminal edges and angles. Not unfrequently the crystal is found much reduced in length, and the truncated extremities become so closely approximated as to give the appearance of a square, the opposite angles of which are connected