DIET FOR GRAVEL AND STONE. 337 



sition of gout. Indeed, the uric-acid condition often alternates in 

 the same individuals with gout; even in generations this may be 

 observed, gout manifesting itself in one, gravel in the second, and 



tout again in the third. It is much more frequent in the United 

 tates than gout. The great object, then, in treating this disease 

 must be the correction of the constitutional disposition and the 

 prevention of the deposit of uric-acid, where this tendency is 

 known to exist. Where gout is known to exist in a family and 

 gravel is at any time observed in the urine, preventive measures 

 should at once be taken without waiting for the actual presence of 

 those symptoms which only occur at late periods of the disease. All 

 then that has been said in other parts of this work on the dietetic 

 treatment of rheumatism and gout may in all cases be appropriately 

 considered with reference to stone. Indeed the strict observance of 

 precautionary regimen is the more urgent in this case, inasmuch as 

 stone is more painful and dangerous than either gout or rheuma- 

 tism. 



Phosphatic salts exist in the urine when in a healthy condition, 

 but are then held in solution. Should the urine, however, be 

 deprived of its normal acidity by inflammation of \he bladder or 

 kidneys, due to an anaemic or broken down state of the constitu- 

 tion, phosphatic gravel may be deposited. It may also form a con- 

 cretion around some irritating substance in the bladder, as a uric- 

 acid stone. This form occurs chiefly in the aged. 



Oxalate of lime, it is always a morbid product. Properly 

 speaking, there is no gravel or sediment; the particles of oxalate 

 float as crystals in the urine, or subside if it be allowed to stand, 

 but not in large quantity. When observed in children this form of 

 gravel occurs in those that have been brought up in the country, but 

 have been underfed, are pale, feeble, and suffer from disturbed 

 sleep, acidity, etc. It seems to be occasioned by their eating too 

 large a quantity of acid fruits and bad vegetables, such as rhubarb 

 sorrel or tomatoes, and drinking hard, unboiled water. It does riot 

 appear to be necessary that the food taken should contain oxalic 

 acid, for by fermentation other organic acids taken into the system 

 may be converted into the oxalic. When the oxalate is found in 

 the urine of adults it appears to be consequent on feeble powers of 

 assimilation and exhaustion of the nervous system from over- work, 

 anxiety or excesses ; on frequent attacks of gout, or on exposure to 

 damp, cold, want of fresh air, and a low, unvaried diet. 



In the treatment of these different forms of the disease it is 

 obvious that first and foremost all avoidable causes must be 

 removed: high living, alcoholic liquors, insufficient exercise on the 

 one hand; over- work, anxiety and excesses of all kinds on the other. 

 Occasional abstinence from animal food for a time is advantageous, 

 except when the oxalic constitutional disposition exists ; then it is 

 necessary to allow a generous animal diet of simply dressed and 

 plain, nourishing meat. Restriction must be placed upon: sugar ^ 



