tained, without any special change in the state of things, terrible exhaustion comes on, and is soon succeeded by complete failure of strength, collapse, and death. In such cases the kidneys are sometimes found to be reduced to little more than mere capsules of fibrous tissue, with scarcely a vestige of secreting structure left, and the wonder is not that death has resulted, but rather that the fatal result should have been so long postponed.

In one case that came under my care some years ago, that of a lady about fifty, who had for years passed a large quantity of highly diluted urine, and died after two or three days' suppression, the cause of the renal degeneration was found to be a stone in the pelvis of each kidney, so situated as to interfere with the free passage of the urine from the pelvis of the kidney into the ureter, but never to completely obstruct it. The renal structure was hard, and there was probably no portion of the cortical part as large as a pea where the normal secretion of urine could be carried on: What is very remarkable is, that this patient had had no renal symptoms whatever at any time of her life. She had often been treated for uterine disturbance, but to within a week of her death had enjoyed fair health. She could walk well, and though never very strong, was active, and able to get through more work than most ladies.

REACTION OF URINE, AND OF THE USE OF ACIDS AND ALKALIES. I fear it must be admitted that with regard to the action of these simple and highly efficient remedies, acids and alkalies, there are many cases in which we still have to prescribe somewhat empirically, or even in a haphazard manner. We meet with cases in which an acid or an alkali respectively seems to be indicated. We prescribe-but their symptoms, instead of being relieved are heightened. The remedy is therefore changed, and that given which it was thought was contra-indicated. Benefit immediately results, and the patient soon gets well. After a time, perhaps, he tries the same plan again, and it signally fails, while this time the remedy succeeds which before was useless.

Many of the derangements in which acids and alkalies are

prescribed depend upon highly complex changes which are little understood as regards their origin and causation. The contents of the stomach may be acid, and the "acidity," as well as the patient's discomfort, increased by giving alkalies, while relief may quickly follow the exhibition of a mineral acid. On the other hand, a case of what would be regarded by some as alkaline dyspepsia, accompanied by the discharge of an alkaline fluid from the stomach, may be cured by an alkali, but caused to return, and in a more severe form, if an acid treatment be persisted in for too long a time. One can only learn how long to prescribe, and when to withhold such remedies, by the careful study of individual cases, and by experiments on one's own organism. The practitioner will often find, in cases which do not improve upon any plan of treatment he has adopted, that benefit will be obtained by judiciously reducing, or by completely withholding food for a time, or by giving one particular kind of food only-in some cases nothing but milk, in teaspoonfuls at a time, and iced; in some, beef tea only; in some, a diet limited to farinaceous food. Indian corn or lentil flour, made into the consistence of gruel with water or milk, and well boiled for a quarter of an hour or longer, often answers. In advising such a course, caution must be exercised, for some patients quarrel with us at the mere suggestion of a diet which they regard as starvation, although to us it might seem fairly liberal. But many who would rebel on the first mention of a plan of treatment considered by us to be necessary, will gradually fall into our views and adopt our recommendations if we only allow them a little time to think about it, and lead them, by degrees, to adopt a restricted diet, instead of insisting that they should pass abruptly from the enjoyment of all the luxuries that money and skill can obtain, to the bare necessaries of existence, without sauce or flavor to tickle the palate. In teaching self-denial to people who have foolishly indulged their appetites to the detriment of their tissues and organs, the medical adviser must be content to work gradually towards the desired end. Sudden conversions to common sense are as rare, if not as impossible, as sudden restoration to health after years of

injudicious eating and drinking and silly management of the body.

The characters of the urine are much influenced by the digestive process; and by the administration of acids or alkalies great changes in its composition as well as in the sensation resulting from the contact of the secretion with the highly sensitive mucous membrane of the urinary organs may be quickly effected.

Acid Urine.-The mucous membrane of both the stomach and bladder is kept in a healthy state by contact with secretion which, although varying in the intensity of its reaction, is in its normal or healthy state acid. The epithelium on the mucous surface remains healthy, and is replaced by new cells at the proper rate, only as long as it is bathed with the acid secretion, and it suffers much, while a long time is required to restore it to its usual condition, if, as not unfrequently happens, particularly in the case of the bladder, the secretion becomes decidedly alkaline. If the latter condition lasts for some time, and especially if the urine becomes highly alkaline, the epithelial surface is practically destroyed, in which case, although the surface may improve up to a certain point, it cannot be restored to its original condition. A highly alkaline state of urine is engendered by the setting free of carbonate of ammonia, by the decomposition of the urea, in cases in which the bladder does not thoroughly empty itself; and if the state of things causing this retention is not remedied, the erosion and destruction of epithelium, of the mucous membrane in its entire thickness, and not unfrequently of structures beneath it, are terrible. Now such a state of things may be prevented, or if it has not been allowed to persist for too long a period, greatly improved or even cured, as far as the working of the organ is concerned, in a very simple way. If the water be drawn off twice or three times a day, and the bladder be carefully washed out once daily with water of the same temperature as the urine-that is a little under 100° Fahrenheit, = 37.7 Cent.—great improvement will result in a few days, and in many cases the patient's distress will be quite relieved in the course of a week. Perhaps in another week

the bladder will act for itself, and the urine need only be drawn off once a day, or the operation given up for a time altogether, especially if the patient is instructed to micturate on his knees, the body being bent forward.

The process of pus formation upon the surface of the genitourinary mucous membrane often begins in the urethra in an attack of gonorrhoea in early life, which soon gets well, but leaves a slightly altered epithelial surface. Here and there a few pus corpuscles continue to be formed, and are from time to time found in the urine. In any slight derangement of the health the process is apt to spread, and it not unfrequently extends into the bladder, and sometimes to the ureters and so on to the pelves of the kidneys. If a patient with these tender patches of epithelium takes cold, the process of pus formation becomes very active and a catarrh of the mucous membrane is the consequence. The morbid action may be established and reach a high pitch of intensity in the course of a few hours, but weeks may pass, especially if the patient be advancing in years, before things return to their general state, for the perfectly normal or healthy condition is seldom quite regained after the age of forty or five-and-forty is passed. The treatment of this condition, and further remarks upon its nature, will be found under the head of "Pus in the Urine."

Bence Jones showed that in health, when the gastric juice was most acid the urine was least so, and vice versâ. Before meals the acid reaction of the urine is most intense. After meals the urine is feebly acid, and it not unfrequently becomes alkaline about three hours after food. This change is associated with disturbance in the system, and feelings are often experienced which are very unpleasant to the patient. Headache, fullness, chilliness and languor are often experienced, and it is by no means uncommon to find persons made quite wretched by the disturbances consequent upon deranged chemical changes.

Sleep and fasting, during which the exhalation of carbonic acid is diminished, "are attended by a rise in the acidity of the urinary secretion" (Ralfe). Highly acid urine very commonly accompanies certain forms of dyspepsia, especially the kind

to which those of a gouty tendency are subject, and it is not unusual to find that the means adopted to reduce the acidity of the urine are effective in improving or restoring the action of the stomach. There is still some difference of opinion concerning the way in which the acid of the gastric juice is produced. The question is well considered in Dr. Ralfe's little book "On the Morbid Conditions of the Urine, Dependent upon Derangements of Digestion," to which I must refer the reader who desires to go more fully into the question. Most probably the hydrochloric acid of the gastric juice is set free during the mutual decomposition of neutral sodium phosphate and calcium chloride. Acid sodium phosphate appears to be the cause of the acid reaction of the urine in many cases, but uric and hippuric acids contribute. In speaking of varying degrees of the acidity of the urine we estimate the acid as oxalic acid. The acid of the urine secreted in twenty-four hours in health is equivalent to about two grammes of oxalic acid.

Although the blood is invariably alkaline, from the presence probably of alkaline carbonates, many of the secretions of the body which are formed from matters taken from the blood are of a decidedly acid reaction. Probably from 300 to -500 grains of acid (irrespective of carbonic acid), calculated as oxalic acid, are formed in the body in twenty-four hours. As I have already remarked, the urine and the gastric juice are usually, in health, very decidedly acid, but the degree of acidity varies much, and in the intensity of their acid reaction these two secretions alternate with one another, and sometimes when one is intensely. acid, the other may be even alkaline. Some of the acids upon which the acid reaction depends are formed within the body. During muscular action, carbonic as well as other acids are formed. Volatile fatty acids, formic acid, acetic acid, lactic acid, and some others, result from changes in the contents of the alimentary canal, and are probably ultimately removed as carbonic acid, but some of them or their compounds may reach the blood and undergo further intermediate chemical changes prior to their elimination. When the action of the liver is deranged there is an accumulation of acid in the system, either