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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 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, thirty-four 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 water.*

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

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On the 16th 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. Under this treatment the symptoms produced by the muriatic acid subsided, but the appearance of the urine was not at first improved.

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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, 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

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

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table-spoonsful 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 diminished in quantity. In six weeks the urine, when voided, was transparent; but a considerable deposition of the phosphates took place, when it had remained for some hours at rest. In this state he left London, and has since informed me that the sediment gradually diminished under the use of the carbonic acid; that his urine is never turbid; and that the irritation in the bladder has entirely subsided.

It did not appear necessary to detail the minutia of the above cases: they have been selected with a view to elucidate the treatment of the disease, as far as it depends upon chemical principles, and to furnish the data upon which the following conclusions are founded.

1. That where alkalies fail to relieve the increased secretion of uric acid, and to prevent its forming calculi in the kidneys, or where they disagree with the stomach, magnesia is generally, effectual; and that it may be persevered in for a considerable time without inconvenience, where the tendency to form excess of uric acid remains.

2. When the alkalies, or magnesia, are improperly conti nued, after having relieved the symptoms connected with the formation of the red sand, or uric acid, the urine acquires a tendency to deposit the white sand, consisting of the ammoniaco-magnesian phosphate and phosphate of lime.

3. The mineral acids (muriatic, sulphuric, and nitric) diminish or entirely prevent the deposition of the phosphates; but are apt to induce a return of the red gravel.

4. That vegetable acids, especially the citric and tartaric, are less liable to produce the last-mentioned effects, even when taken in large doses for a long time; and that carbonic acid is particularly useful in cases where the irritable state of the bladder prevents the exhibition of other remedies.-Phil. Trans.

CRITICAL

CRITICAL ANALYSIS

OF RECENT PUBLICATIONS

IN THE

DIFFERENT BRANCHES OF PHYSIC, SURGERY, AND MEDICAL PHILOSOPHY.

Tracts on Delirium Tremens, on Peritonitis, and on some. other internal Inflammatory Affections; and on the Gout. By THOMAS SUTTON, M.D. of the Royal College of Physicians, late Physician to the Forces, and consulting Physician to the Kent Dispensary. 8vo. pp. 272. London, 1815. Underwood.

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IN noticing the diseases treated of in the present work, we shall pursue the order adopted by the author. The first complaint which claims our attention is a variety of phrenitis, with which disease, indeed, it has hitherto been confounded, so much so that Dr. Sutton, we believe, is the only writer who has regarded it as a distinct malady. He names it Delirium Tremens from an essential symptom of the complaint. Now, as we find nothing in the history of this affection to induce us to separate it from phrenitis, would not the term Phrenitis è temulentia be more appropriate than the one suggested by the author? In all the cases he has met with, drunkenness, or indulgence in liquor, mainly produced the complaint; and if Phrenitis be proper as the genus, è temulentia will mark the species. Delirium and tremor occasionally constitute symptoms of typhus fever, and several other diseases in their latter stages, and on that account, in our opinion, render the term delirium tremens objectionable to designate a mere variety of phrenitis. It, perhaps, will be alleged that the disease in question cannot be a species of phrenitis, because the treatment to be pursued in the two affections is directly opposite; but this argument has no weight with us, when we consider that there is hardly a disease of importance, or a variety of a disease, which does not require very different treatment in its progress, or as it appears in a particular patient. Bronchitis acuta is not to be treated like bronchitis asthenica.

The merit of Dr. Sutton, however, neither consists in describing a new disease, nor in calling an old one by a new name: it rests upon separating a series of symptoms produced by a certain cause, from a well-known complaint, with which they have been confounded, and bad practice has

in consequence been generally pursued. It has been usual to treat delirium tremens (as the doctor would have us term the affection) as phrenitis; but, during his residence on the coast of Kent, he found two modes of treating the complaint prevailed, the one by bleeding and depletion, the other by opium. The latter practice was the most successful, but the practitioners who had adopted it could assign no reason for the faith within them: they administered it because they found it useful. "I know, from experience, (said a physician to whom Dr. Sutton applied for information on the subject) that opium is of great use in this disease, and that when sleep is procured, the patient more frequently gets better; but I have nothing to guide me to form an opinion from, as to what may be the state of the brain, nor in regard to the modus operandi of the remedy, than that the measure of its beneficial efficacy is by procuring sleep.'

The history of this complaint, as related by the author, is highly interesting: we have already noticed it in our Halfyearly Report of the Progress of Medicine, in the volume, page 17, to which we now refer.

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This accurate account is followed up by several cases which illustrate the author's treatment, and detail of symptoms. In the first, the patient had labored under, acute rheumatism for ten days; and for three days previous to Dr. Sutton's visiting him had been very delirious, and without sleep.

"When I saw him (the doctor writes) he had a strait waiscoat on; of course might be considered to have been very ungovernable. He had been bled in the course of the day, and the blood was buffy; the bowels had been acted on freely; a stimulating composition had been applied to the head, and a blister between the shoulders: notwithstanding which, all the symptoms had become worse. The pulse was very quick there were continual workings of the tendons, with considerable tremors, and profuse sweats. After making inquiry respecting the habits of the patient, and collecting all the information I judged to be necessary, I proposed to administer forty drops of laudanum in a draught every two hours, until sleep was procured. Three of these draughts were given in succession, when the patient

"Dr. Saunders observed, that he knew no disease in which the pulse became so rapid, and recovery ensued, as in numerous cases of this affection; which perfectly accords with my observation: but the recoveries alluded to have been effected by the treatment which is about to be pointed out, the efficacy of which, and its preference to all others, Dr. Saunders has been confirmed in, from a long experience, and attentive observation. I never saw a case of recovery, when the pulse was very rapid, except by the employment of opium."

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