B54 Additional Observations 
stantly observed in the urine began to decrease, but the 
white sand remained as abundant as before; he was there- 
fore 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 ob- 
served 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 ad- 
dition of ten drops of Jaudanum to each dose of the citric 
acid prevented this effect, and he was thus enabled to con- 
tinue 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 patien§, 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 urie 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 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 treatmient. 
_Lemon juice, or a solution of the pure citric acid, when 
given in quantity sufficient to produce any change in the 
* Practical Observations on the Treatment of Diseases of the Prostate 
land, D- 39, 
appearance 
