consume. given them to considerably increase the quantity of liquid they But although you may find it impossible to persuade them to increase the liquid to three or four pints daily for a month or two, you may get them to submit to the régime of a German bath, where they will imbibe a larger quantity of fluid than you have advised them to take. That a large quantity of liquid disagrees with many persons is certain, but nevertheless those who are the subjects of rheumatism or gout, or of uric acid deposits, or of calculous formations, will do well to gradually bring themselves to the habit of taking considerable quantities of fluid, though they may find at first that the new practice does not suit them. Such persons, taking freely of liquid will require less food, and will gain in health thereby, as well as from the free dilution of the intertextural fluids and the consequent assistance afforded to the free action of the secreting organs in every part of the body. A widespread prejudice against the imbibition of liquid has been fostered by bad arguments, and by the fear of introducing diseasegerms into the organism. This latter danger can always be guarded against by simply having all water used for drinking boiled for a quarter of an hour or longer and allowed to become cold in a clean pitcher before it is taken. Notwithstanding all that has been said to the contrary, there is no doubt that in the cases we are considering the most important part of the treatment-and that for which no alternative or substitute can be found-is the administration of plenty of water-boiled water, toast-and-water, mineral waters, lemonade, effervescing citrate of magnesia (potash), or soda, tea, weak coffee, or cocoa, barley-water, linseed-tea—as may be preferred; but water, to the amount of at least two pints during each period of twenty-four hours, should be taken by those who have exhibited tendencies to the frequent deposition of the imperfectly soluble constituents of the urine or to the formation of actual calculi; neither beer nor wine-however diluted-will do; spirits will do harm, even if diluted with very considerable quantities of water-unless the patient is restricted to very small quantities, say from one to two ounces only. We are, perhaps, too apt, in many chronic cases, to put invalids upon a plan of treatment for only a few days or weeks; and our patients are often unreasonable enough to expect that the remedies we prescribe will remove, in a week, matter which has been slowly accumulating, perhaps, for years. It is difficult to impress upon those who suffer the immense importance of allowing time for the beneficial operation of the therapeutic system to which they are subjected. Little benefit can result from adopting a special diet and medicinal system for a month or even a few months, in cases where the derangements to be counteracted have persisted for years, and the tendency to the formation of the deposit in abnormal quantity has been transmitted perhaps through several generations. It is chronic cases of the kind under consideration which receive such real benefit from the comparatively prolonged course to which they are subjected in a German bath or hydropathic establishment; and it too often happens that, in endeavoring to perform quickly, by remedies, that which it is only possible to effect by giving large quantities of fluid during a considerable period of time, we disappoint ourselves and our patients. Exercise, when it can be taken, is of the utmost importance. Hot baths, Turkish baths, etc., are beneficial, because they promote sweating and excite thirst. Thus more fluid is ingested, which is soon got rid of by various emunctories, and carries out with it insoluble substances. The fluid which is removed is soon replaced by a fresh quantity. In the frequent repetition of these processes from time to time a vast quantity of fluid is made to pass through the body, with the most beneficial results. We seldom find difficulty in prevailing on patients to take Seltzer, Vichy, or other alkaline waters daily, or a few doses of the effervescing citrate of magnesia now sold so largely, although it would be useless to recommend them to take pure water. They may take the waters with their wine at dinner, the last thing at night, and in some cases it is desirable that the patient should take the water the first thing in the morning. People who live well every day, or rather too well, will find great advantage from continuing this plan, and now and then taking small doses of alkalies. It is quite superfluous for me to enter into the minute details applicable to individual cases; but I cannot too strongly recommend a careful inquiry into the general mode of life of patients of this class; for permanent relief may be afforded if we can but convince them of the importance of constantly attending to simple rules based on the principles to which I have directed attention. We must not forget, in the treatment of cases of renal calculus, the very great importance of keeping the patient's general health as good as possible. Many forms of chronic disease cause suffering in proportion to the degree of weakness which prevails, and a pain easily borne and, perhaps, scarcely to be noticed when the patient is well, becomes of a most severe character if his health fails. The very remedies we employ to mitigate his suffering too often disturb his digestive organs, and though for a time a little relief is given, little or no real advantage is gained. It is of consequence to attend to the action of the bowels, for, although by purging we cannot cause a stone to be removed from the kidney, we shall invariably find that the pain and suffering are much increased whenever the bowels become torpid. We observe the same fact in cases of neuralgic pain, and, not unfrequently, severe toothache ceases as soon as a purgative— particularly a mercurial—begins to act. Saline purgatives often act well. They not only empty the large intestine, but a part is absorbed and acts as a diuretic; the stone being moved a little, or, at any rate, a passage between it and the walls of the ureter in which it is impacted being made by the washing away of mucus and débris which had accumulated, and which with the stone caused for a time complete obstruction. On Dissolving Urinary Calculi.-Many of the observations which I have made with reference to the prevention and removal of the conditions upon which the formation of urinary deposits depend, are also applicable to calculi of allied composition. When uric acid or urate of ammonia calculous matter, for instance, has been deposited, it may be dissolved, or its in crease may be prevented by producing alterations in the chemical composition of the urine; and such alterations may be effected partly by diet, and partly by the administration of various remedies, especially alkalies and the salts of the vegetable acids. An Mere dilution of the urine will sometimes exert a considerable influence upon a calculus; and it is probable that many soft or porous calculi have been entirely dissolved in this manner. acid state of urine would tend gradually to dissolve a phosphatic calculus; and it is very likely that if a feebly alkaline condition of the urine be maintained for a considerable time, an impression would be made upon some forms of urate and uric acid calculi. The irregularities often seen upon the surfaces of such calculi have been very properly termed "water-worn," and clearly indicate that the urine has exerted, for a time at least, a solvent action. Although in certain cases it would undoubtedly be right to adopt for a time treatment of this kind, we must not look forward to a favorable result with very great confidence; at best, such changes are tedious and uncertain, and in some cases cannot be effected at all. Although in the laboratory we succeed in dissolving many deposits and calculi, it is, in fact, comparatively seldom we are able so to alter the composition of the urine and maintain the changed characters for a sufficient length of time to effect solution, except in very rare instances. Many attempts have been made to dissolve the calculus by injecting fluids which exert a solvent power upon the stone, into the bladder. The most convenient plan is to inject the fluid, heated to a temperature of 100° Fahrenheit, through a double catheter, for half an hour every two or three days or more frequently. Dr. Willis recommended that the fluid should be placed in a reservoir at a sufficient height above the patient, and connected with the catheter by a tube provided with a stopcock, by which means the flow of the solvent could be carefully regulated. In carrying out this plan, it is very important that the solution should be so weak as to prevent all chance of the mucous membrane of the bladder being injured. Sir Benjamin Brodie showed that phosphatic calculi might be greatly reduced in size, or entirely dissolved, by injecting a weak solution of nitric acid (2 to 21⁄2 minims of strong nitric acid to two ounces of distilled water). Such a solution would also act very favorably in removing the sharp edges of some phosphate stones and small fragments remaining in the bladder after the operation of lithotrity. The objection to the use of alkalies in attempting to effect the solution of uric acid or urates is, that phosphates are precipitated from the urine, and the calculus soon becomes not only protected from the further action of the solvent, but its size increased. A very ingenious plan for dissolving calculi was proposed some years since by Dr. Hoskins, who employed a weak solution of acetate of lead (one grain to the ounce) with a mere trace of free acetic acid. With a phosphatic stone, double decomposition occurs. Phosphate of lead, in the form of a fine granular precipitate, and an acetate of lime and magnesia, are formed. The solution, it need hardly be said, does not produce any irritation or unfavorable action upon the bladder.. In many cases all our attempts to remove the stone by effecting its solution will be ineffectual, and we shall have to call in the assistance of the surgeon, who may remove it entire by lithotomy, or crush it with the lithotrite into several small pieces, which escape by the ordinary channel. -- very Experiments Concerning the Solvent Action of Alkaline Carbonates. Dr. Roberts demonstrated 66 that weak solutions of the alkaline carbonates dissolved uric acid calculi with considerable rapidity, while stronger ones altogether failed. In order to decide what strength of solution had the most solvent power, fragments of uric acid, weighing from 40 to 112 grains, were placed in 10-oz. phials, and solutions of carbonate of potash and soda of various strengths were passed over them at blood heat. The experiments were continued day and night; and the daily flow of solvent varied from 6 to 15 pints. "Operating in this way, it was found that above a strength of 120 grains to the pint no solvent action was exerted; and even with 80 grains to the pint there was only a little; but solutions |