rhous pylorus. In all, but particularly in the first and last cases, the symptoms and appearances of poisoning by oxalic acid were well marked, which led me to examine the egesta for this poison, but I could detect none. In such cases as the preceding, guided solely by the symptoms, we should most certainly form an erroneous diagnosis; and here the value of microscopic, as well as chemical analysis of the urine, becomes apparent. The symptoms should not, however, in any case be undervalued; but when we can with certainty, and by a simple process, discover the cause which produces certain symptoms, we can with more confidence select the proper therapeutic agent. We, moreover, observe from these, that in all cases where the oxalate of lime is in octohedral crystals, the nitro-muriatic acid, combined with a vegetable tonic, will in most, if not in all cases, effect a cure.

2. That in those cases where the crystals assume the dumb-bell form. nitrate of silver appears to be particularly serviceable.

3. That when both kinds of crystals are present, these medicines should be given alternately.

The internal use of nitrate of silver has been generally objected to, from the effect it produces on the skin. I have frequently given in repeated doses of one grain, as much as 60 grains, without producing any discoloration.-Glasgow Med. Journal, Oct. 1853, p. 311.

72.-ON MORBID CONDITIONS OF THE URINE CONNECTED WITH CHRONIC DISEASE.-INDIGESTION.

By DR. H. BENCE JONES, F.R.S., &c.

[Some time ago Dr. Bence Jones pointed out that frequently in a healthy person, when much acid exists in the stomach, the urine becomes alkaline. It becomes thick when boiled, but clears with nitric acid. This alkaline state of the urine is often caused by an irritable stomach, that is, indigestion, owing to insufficient air and exercise. It is not permanent, but varies in the same day, and exists only or chiefly when the stomach contains acid.]

The indications for treatment of alkalescence from fixed alkali

are:

1st. To remove the cause; that is, to lessen the irritability of the stomach.

2ndly. To correct the state of the urine.

In the slight form of the disorder which probably is frequently to be met with in many of us, little or no medical treatment is requisite. Less work, more air and exercise, mild, unirritating, nutritious food, will remove the alkalescence, which for the most part can be found by emptying the bladder directly after breakfast, and again in two hours. In severer cases, acids and tonics are indicated.

Of acids, the vegetable acids are most efficacious in correcting the state of the urine. They can be taken in larger quantities than the

mineral acids, the intensely acid taste of which prevents a great increase in the dose.

The most frequent method of giving vegetable acid is in lemon juice, which has no definite composition. The specific gravity of one specimen I found was 10384; another, 10360; a third, 1037.9. Supposing that half an ounce saturates a scruple of carbonate of potash, then seventeen grains of dry citric acid are equivalent to half an ounce of lemon-juice. Each lemon contains about an ounce of lemon-juice, so that a lemon is equivalent to about thirty-four grains of citric acid, and twelve ounces of lemon-juice would equal six drachms, two scruples, eight grains of citric acid, or 408 grains. Now, I have found by experiment that this quantity of lemon-juice, taken in two doses of six ounces each dose, repeated in three hours, did not cause any pain in the bowels, and it occasioned very little uneasiness to the stomach, which was empty when the first dose was taken. It very decidedly increased the acidity of the urine, and it distinctly precipitated uric acid when the urine stood for some hours. This may be considered as resembling the effect of about 408 grains of citric acid in twelve ounces of water. Tartaric acid was taken dissolved in distilled water, in two doses of fifty-four grains each, in an hour and a quarter, without any uneasiness, but it caused very considerable pain in one hour. The pain, which was markedly intermitting at short intervals, lasted nearly three hours. Then the bowels were inclined to act, but no action took place. This was the effect of 108 grains of tartaric acid. A second experiment, in which 162 grains were taken in an hour and three-quarters, caused the same symptoms. The acidity of the urine was considerably increased.

It is probable from these experiments, that—

1. The solution of tartaric acid was not absorbed from the stomach, but passed into the intestines, and would have passed, partly at least, through them. 2. That the stomach is less sensitive than the intestines. The pain was not felt in the stomach, but was very severe in the bowels. 3. Tartaric acid is more than twice as irritating as citric acid in lemon-juice. The quantity of potassa in lemon-juice is too small to produce any very decided neutralising effect, the total ash in an ounce of juice being less than a grain and three-quarters.

[But there is another kind of alkaline urine, viz., that from volatile alkali, the first being from fixed alkali.]

The alkalescence from volatile alkali, whether caused by injury of the spinal cord, or from any other cause, owes its origin generally, if not always, to inflammation of the mucous membrane of the urinary organs. This gives rise to altered mucus and pus. The mucus determines the decomposition of the urea, changing it into carbonate of ammonia, which neutralises the acidity of the urine, and finally precipitates the phosphate of lime, and forms phosphate of ammonia and imagnesia, which afterwards crystallises out. The carbonate of am

71.-ON THE TREATMENT OF OXALURIA.

By DR. JAMES GRAY, Glasgow.

[The terms oxaluria and oxalic acid diathesis are now well understood to mean that morbid state of the digestive and assimilative functions in which oxalic acid is eliminated by the kidney in combination with urine. It is by no means an uncommon complaint. The prevailing forms of the crystals are the octohedral and the dumb-bell. It is at present believed that the former consists of the oxalate, and the latter of the oxalurate, of lime; and this is likely, because therapeutic agents do not act alike in both cases. Dr. Gray, in this paper, endeavours to show the value of the nitrate of silver in cases where the dumb-bell form is present.]

Case 1.-James Fleck, aged 48, of a melancholic temperament, married, by trade a cooper; came under my care on the 3rd of Aug. 1851, complaining of intense pain in the epigastric region, so severe as to render him wholly unfit for his work. He attributes the first of his present illness to a debauch about three years ago, up to which time his general health had been good.

When I saw him he had a very haggard and emaciated appearance; skin of a greenish-yellow colour, tongue red, pulse regular, but weak. Complains of excruciating pain in the region of the stomach, both before and after taking food. This pain comes on in paroxysms, and is frequently attended with vomiting; the matter vomited has a dark grumous appearance, During the paroxysm the skin is cold and bedewed with moisture. Bowels confined, fæces of a dark colour; has occasional pains over the renal region. To take a mild aperient, and a wine glassful of calumba infusion thrice daily.

5th. No change for the better, pain still as severe. Is greatly depressed, and under the impression that he is consumptive and dying. This morning's urine has a dark amber colour, acid, specific gravity 1030, contains a large excess of urea; under the microscope, numerous octohedral crystals of the oxalate of lime, mixed with epithelial scales in great numbers, are visible. To have a nutritious diet, to abstain from spirituous liquors, to sponge the body every morning with tepid water, and to take a teaspoonful of the following mixture every six hours;-Tincture of calumba, ij; nitric acid and muriatic acid ăă 3ss.

8th. Greatly improved in appearance. He is now quite free from pain, is in better spirits, and takes his food with greater relish.

He went to the country shortly after this, and returned to his work about the beginning of November perfectly well.

On the 15th of Feb. following, he returned to me with all his former symptoms aggravated; which he attributed to irregularity in diet and exposure to cold. On examining the urine it was found to contain the oxalate of lime in dumb-bell crystals.

He was ordered to take a mild aperient, and the acidulated tincture of calumba as before.

18th Feb. Bowels freely moved, no improvement, passed a very bad night. Ten drops wine of colchicum every six hours, and grain sulphate of zinc, night and morning.

22nd. Much the same, is evidently weaker and more emaciated, can take no food, greatly depressed in spirits. One grain nitrate of silver every six hours.

24th. Felt greatly relieved after taking the first dose of the nitrate of silver, is now improved in appearance. The paroxysms are less frequent and not so severe. This morning's urine contains the oxalate of lime in octohedral and dumb-bell crystals. Continue the nitrate of silver ingrain doses; a teaspoonful of the acidulated tincture of calumba night and morning,

March 3rd. Decidedly improved. The dumb-bell crystals have disappeared from the urine. Omit the nitrate of silver and continue the

mixture.

April 10th. No trace of the oxalate of lime in the urine. He feels quite well, and has again resumed his work.

On the 3rd of Dec. last I was called to see him. I found him in bed, perfectly prostrated, with a small thready pulse, weak tremulous voice, skin cold and clammy, features contracted, countenance expressive of intense pain, low moaning, tossing of the arms, breathing slow, tongue white and coated. I learned that while at work this morning the pain had returned, and that he was induced by a fellow-workman to take two glasses of whisky, which increased the pain and brought on vomiting. Sinapism to the epigastric region, warm drinks, and bottles of hot water round the body.

The urine, on examination, was found to contain myriads of dumbbell shaped crystals of the oxalate of lime, mixed with uric acid. Nitrate of silver in grain doses every four hours.

4th. Pulse fuller, no decided improvement in the other symptoms. 7th. Has improved greatly. The pain has now all but left him. Continue the nitrate of silver in grain doses three times a-day.

On the 14th he went to the country, and returned to his work on the 27th. Up to this time he continues well.

Case 2.-On the 29th of April, 1852, I was consulted by J. R., aged 23, of a nervous temperament. He has been ailing more or less for the last nine months. Complains of pain and difficulty in swallowing, harassing cough, with roughness at the upper part of the larynx. When the cough is severe, the expectoration is tinged with blood: no appetite, bowels constipated, great weakness and emaciation, tonsils enlarged, and fauces considerably inflamed, tongue slightly coated. Percussion elicits a normal sound over the whole chest.

A strong solution of the nitrate of silver was applied to the upper part of the larynx and fauces, and he was ordered a mild laxative. 30th. The urine contains an excess of urea, and oxalate of lime in

octohedral crystals. A teaspoonful of the acidulated tincture of calumba three times a-day, He went to the country shortly after this, and returned about the beginning of June, so much improved as to be able to resume his duties. No trace of the oxalate could be detected after his return, and with the exception of a few days' confinement to his room from an attack of "cynanche tonsillaris," he has since then enjoyed good health.

Case 3.-J. M'Intosh, aged 25, ship cooper, came under my care on the 2nd Jan. 1852. From his history it appears that when at Georgetown, Demerara, he was very irregular and intemperate in his habits, that on the voyage home he was attacked with sickness, vomiting, headache, and loss of appetite, by which he was greatly reduced in strength, and confined to his berth for the greater part of the voyage, and since his return on the 18th of Nov. 1851, he has been confined to bed.

Complains of great feebleness, and of daily becoming weaker. The countenance is wan, and expressive of great anxiety. Tongue coated posteriorly, red at the point and edges; has no desire for food, and what he does take is often rejected, bowels loose, severe spasmodic cough, respiratory murmur healthy; profuse perspiration, particularly at night, and after awakening from sleep; pulse 120, weak and small, heart's action normal, urine of a dark amber colour, density 1035, contains oxalate of lime in octohedral crystals, with a large quantity of the urate of ammonia. A mild nutritious diet, tepid sponging night and morning, a tea spoonful of the acidulated tincture of calumba every four hours.

Under this course of treatment he continued to improve daily. About the 1st of Feb. he went for a few weeks to the country; on his return no trace of the oxalate of lime could be detected. Since then he has enjoyed good health.

Case 4.-John Anderson, aged 34, nervous temperament, by trade a cabinet-maker, consulted me on the 6th of July, 1852, for what he conceived to be an affection of the stomach. He informed me that about the middle of April preceding he began to lose his appetite, had slight pain in, and distension of the stomach, frequently accompanied by heartburn, palpitation of the heart, and pain in the loins. When he called on me in July these symptoms were considerably aggravated; his pulse was 84, strong and full, the slightest excitement caused palpitation of the heart, and severe headache. He has no appetite for food, which when taken causes pain in the stomach, flatulence, and sometimes vomiting. Bowels confined, urine of a pale yellow colour, specific gravity 1042, contains oxalate of lime in octohedral and dumbbell shaped crystals; a small quantity of urate of ammonia and epithelial scales. Acidulated tinct. of calumba every four hours, a grain of nitrate of silver night and morning, tepid bath, and to abstain from vegetable food.