212 Brande on the Medico-Chemical 



candidly considered the subject, and whose experience has made 

 them judges of it, that that stone can never again be dissolved ; 

 and although it is possible that it may become so loosened in 

 its texture as to be voided piece-meal and gradually to crumble 

 away, the chances are so much against such an event, that it is 

 scarcely to be ranked among probable occurrences. 



In considering, then, the treatment of calculus of the bladder, 

 our attempts are to be directed to the palliation of present 

 symptoms, and to the prevention of increase of size of the stone. 

 Opiates, and the warm bath, and other remedies of that descrip- 

 tion, may here be passed over, in order to consider the more 

 abstract chemical treatment. 



By the inspection of collections of calculi, we are taught that 

 in by far the greater number of cases, a nucleus of uric acid is 

 enveloped in a crust of the phosphates ; our endeavours, there- 

 fore, must be directed towards reducing the quantity of uric 

 acid in the urine to its natural standard, when in excess ; and to 

 diminishing, as far as may be, the tendency to the deposition of 

 the phosphates, and (as is obvious from the account of the treat- 

 ment of sand given above,) (Vol. VI. p. 195.,) two very different 

 means being required to attain this end, the impropriety of 

 applying one mode of treatment to all calculous cases becomes 

 too evident to require any further refutation. 



If, upon examination, it be found that the urine abounds in 

 uric acid, and if, as is frequently the case, red sand is voided, 

 magnesia and the alkalis may be resorted to, but they should 

 not be persevered in beyond what is necessary to arrest the 

 progress of the uric secretion ; or if continued as preventives, 

 they should be exhibited in small doses. It is here especially 

 that magnesia proves useful, for it is less apt to occasion indi- 

 gestion and its attendant symptoms, than any other alcaline 

 medicine. 



If the phosphates predominate, and if white sand is voided, 

 the acids may be resorted to ; but in consequence of the more 

 irritable state of the parts, it becomes, more than ever, necessary, 

 to use them with circumspection. In general, the white sand 

 voided by patients suffering under stone of the bladder, is 



