STONY CONCRETIONS IN THE BLADDER. 79 



diagnosticated, it is usual to administer alkaline carbonates, quite re- 

 gardless of the chemical nature of the stone, and to send well-to-do 

 patients to Vichy or Karlsbad, those springs having a world-wide 

 reputation as remedies against lithiasis. Perhaps the benefit derived 

 from this mode of treatment depends upon the effect of the remedies 

 upon the vesical catarrh, which is one of the main causes of the affec- 

 tion. According to MecJceVs theory, the exhibition of the alkaline 

 carbonates and salts of the vegetable acids is indicated, because the 

 urine is thereby rendered alkaline, and the metamorphosis of a stone, 

 consisting of oxalate of lime, or of uric acid, into a softer and more 

 friable phosphatic calculus, is promoted. At all events, we strongly 

 advise that the old method of treatment be adhered to, and that no 

 new " cures " be adopted, based merely upon a priori reasoning. Be- 

 sides the alkaline carbonates, and the basic phosphate of soda, of 

 which about two drachms may be taken daily, the carbonate of lithia 

 has of late obtained a great reputation as an antilithic, and is warmly 

 recommendedby many. I should attach little weight to such recom- 

 mendations, were they based solely upon the theoretical ground that 

 the carbonate of lithia has a solvent power of uric acid six times as 

 great as that of bicarbonate of soda. But, as we have some reports, 

 upon good authority, of good clinical results obtained by its use, I 

 admit the propriety of making further experiment with this drug 

 (lithiae carb. gr. j v t. d.). The Wildunger, Vichy, or Karlsbad 

 waters may also be used as a beverage. 



We have already discussed the mode of treating the catarrh and 

 haemorrhage of the bladder to which calculus gives rise. The opera- 

 tion for stone in the bladder is a matter for the surgeon. 



NEUROSIS OF THE BLADDER. 



WE are still hi need of considerable physiological light as to the 

 normal innervation of the bladder, and to the process of micturition. 

 It is difficult satisfactorily to account for the well-known facts that a 

 healthy man is often unable to pass water when required to do so in 

 the presence of a stranger who watches him, and that the first attempts 

 of a novice to make water while on horseback or in a wagon are often 

 attended with difficulty, while these things are easy enough to one 

 who is accustomed to them. Nevertheless, our comprehension of the 

 nervous disorders of the bladder will be facih'tated if we classify them 

 into motor and sensory neuroses, and subdivide the latter class into 

 hyperassthesia and anaesthesia, the former into hypercinesis and acinesis. 



