GRAVEL. 



when the vessel is slowly tilted so as not to trouble the general transparency of the 

 water. With a little care no difficulty will be experienced in distinguishing true 

 from false gravel. 



There is no doubt that a tendency to the formation of gravel is hereditary. This 

 hereditary tendency varies in force or strength in different families. Some people 

 begin to pass gravel at thirty or sooner, others at forty, and again others not till 

 they are sixty. As a rule, the earlier the age at which it makes its appearance, the 

 stronger is the hereditary predisposition, and the more difficult will it be, in all pro- 

 bability, to effect a cure. There is a curious relationship between gravel and gout. 

 Sometimes these two complaints seem to alternate, comparing one generation with 

 another ; thus, gout appears in the one, gravel in the second, gout again in the third, 

 and so on. And the same individual may have alternate attacks of gout and gravel, 

 ami this is by no means uncommon. The majority of people who suffer from this 

 condition live an indolent and luxurious, if not an intemperate life. Adults are 

 peculiarly obnoxious to it after the age of forty. They are usually in addition 

 troubled with transient twinging pains in their limbs, and often during an " attack 

 of gravel " suffer from pain in the back and a general sense of discomfort. Some 

 l>eople pass gravel daily and habitually, whilst others do so only every few weeks, 

 but then in considerable quantity. These attacks occur at varying intervals, and 

 usually increase in frequency and severity unless treatment is resorted to. 



The presence of gravel in the urine is not to be regarded as an indication of 

 kidney disease. In the vast majority of cases it means simply that the liver is inactive. 

 It fails to perform its duty as an excreting organ, and the result is that an extra 

 amount of work is thrown on the kidneys. In the case of people who suffer froni 

 gravel it will usually be found that the bowels are sluggish, that the appetite is 

 impaired, and the digestion is performed imperfectly. These may not be very pro- 

 minent symptoms, especially if the diet be carefully selected, and the patient is able 

 to take plenty of exercise and pass most of his time in the open air, but still they 

 are always present more or less. 



It is obvious from what we have said that our treatment should be directed 

 rather to the liver than to the kidneys. A most valuable drug in these cases is 

 blue-pilL But still it must be remembered that gravel is essentially a chronic 

 complaint, and one cannot indulge in blue-pill to an unlimited extent. We have 

 consequently to look round for some drug or combination of drugs that will prove 

 equally efficacious, but will be less likely to act injuriously on the system if continued 

 for a considerable time. We find what we require in certain natural mineral waters, 

 such as the Friedrichshall and Pullna, and of these the former is usually preferred, 

 on the grounds that it does not purge too freely, that it does not gripe, and that it is 

 not very disagreeable to take. The dose of Friedrichshall water is about half a 

 tumblerful, and it should not be taken pure, but diluted with from a third to half 

 of its bulk of hot water. A great advantage is that it may be taken for many 

 weeks without losing its effect. It should be taken in the early morning, say an 

 hour or so before breakfast ; and then, after the cup or two of hot tea or coffee 

 accompanying that meal, there is usually a full, free action of the bowels. Some 

 people prefer the Marienbad water, which contains enough free carbonic acid to make 



