XXVI. Additional Observations on the Effects of Magnesia in preventing an increased Formation of Uric Acid; with Remarks on the Influence of Acids upon the Composition of the Urine. By William Thomas Brande, Esq. F. R. S. Prof. Chem. R. I. Communicated by the Society for improving Animal Chemistry.

Read June 3, 1813.

In a paper which I had the honour of laying before this Society, about three years ago, and which is published in the Philosophical Transactions*, some cases are related, illustrating the effects of magnesia in preventing an increased formation of uric acid, and some experiments are detailed, instituted with a view to discover its mode of action.

Since that period many opportunities have occurred, both to Sir EVERARD HOME and myself, of confirming its efficacy upon a more extended scale, and of ascertaining the efficient treatment of those cases in which magnesia is ineffectual, and in which it has even been found to aggravate the complaint.

To bring forward additional evidence in favour of the use of magnesia, and to distinguish the cases in which its use is indicated, from those where it is improper or hurtful, are the principal objects of the present communication, and will be considered in the two following sections.

For 1813, p. 106.

SECTION I.

The following is the case of a gentleman who suffered from a calculous complaint, during which he was accidentally induced to employ magnesia, the effects of which he has thus described.

Case 1. About twenty-seven years ago, I felt a pain in one of my kidnies, particularly when in bed, which continued to increase during six months. I had likewise an occasional sympathetic pain in the testicles, and violent and excruciating pains in the left kidney now became frequent. These attacks were sometimes brought on by stooping to take up something; but at other times without any apparent cause. They lasted from twelve to twenty-four hours, and I obtained some relief from the application of warm flannels; but they always left me languid and relaxed.

On the fourth attack I consulted a physician, who imagined that my complaint had been induced by drinking cyder, in which I had formerly indulged. He ordered me weak Hollands and water for common drink, and prescribed the lixivium of tartar to be taken in broth. This medicine was persevered in for some time; but I found it gradually weaken my stomach, and impair my digestive powers.

About nine months after my first attack in the kidney, I walked from Hampstead to London after dinner, and on the following day, I clearly felt something pass from the kidney to the bladder, and suspected what it was. I took about a pint of Hollands and water, and on attempting shortly afterwards to void my urine, found that the passage was blocked up, but had scarcely time to consider of my situation before the

obstruction moved forwards to within an inch of the extremity of the urethra: it remained there till the following evening, when, by the help of a small pair of watchmaker's forceps, I succeeded in extracting a stone, which was the source of the mischief.

It was jagged and rough, and of a deep brick-red colour. I afterwards voided a considerable quantity of red crystalline sand.

My physician, who was apprehensive of a return of the disorder, desired me to purchase of CADELL, an anonymous pamphlet upon the Stone and Gravel, and to observe the rules there laid down. This treatise particularly recommended the use of the alkalies. I therefore took the lixiviuin, and two bottles of PERRY's solvent; but the red deposit in my urine continued, my loins felt weak, and when in bed very painful.

Being in the profession of the law, and much employed, I was under the necessity of leading a very sedentary life, which so aggravated my tendency to bile and indigestion, that I seldom could get above two or three hours sleep.

With a view to alleviate these symptoms, and not with any idea of its being beneficial to the stone, I resorted to magnesia, which I continued with little intermission for eight months in the dose of a tea-spoonful or two, every evening before I went to bed. The long vacation coming on, I gradually took more exercise, and used the cold bath. The tone of my stomach, at the end of the period I have mentioned, was so far restored as to induce me to set medicine of all kinds aside, except when any food or drink disagrees, when I occasionally resort to the magnesia. Under such treatment, the weakness and pain in my kidney left me, and the red sand entirely disappeared. I

have since enjoyed a very good state of health, and am now in my fifty-seventh year.

If I occasionally make a little free with the good things of this world, my stomach reminds me of the improper use of the lixivium, especially when I am prevented taking my usual exercise.

The above case is important, not only as furnishing a striking and unprejudiced instance of the effect of magnesia, in counteracting the tendency to form uric calculi and gravel; but likewise, as demonstrating its efficacy where the alkalies had failed, and where the digestive organs had been injured in consequence of the use of such remedies: the time which has elapsed since the cure of this and other cases, without a relapse, is also strongly in favour of this mode of treat

ment.

Case 2. A gentleman twenty years of age who had suffered from heartburn, and other dyspeptic symptoms, was seized, on the 1st of June, 1811, with a violent pain in the loins, and more especially in the right kidney, and during the night he passed a large quantity of red sand with his urine. On the 2d, with a view to relieve the pain, which had increased considerably, he took fifty drops of laudanum, and drank freely of barley water. The night was passed more quietly, but on the morning of the gd, he was seized with a violent pain in the kidney, and with the usual symptoms of the passage of a calculus along the ureter. These continued with more or less violence till the evening of the 4th, when he became perfectly easy, and remained so till the morning of the 6th, when, with

considerable pain and difficulty, he voided a calculus composed of uric acid, weighing nine grains. For several successive days his urine deposited a large quantity of red sand, and three very small round calculi were voided.

He was now directed to abstain from all kinds of fermented liquors and sour food, and to take a pint of treble soda water, (containing three drachms of sub-carbonate of soda,) daily. Under this treatment he continued to recover, and remained perfectly free from complaint until the end of August, when a copious deposit of red sand appeared in his urine: he had little pain in the affected kidney, but complained of almost constant nausea, or want of appetite. The soda water was increased to a pint and a half, and afterwards to two pints daily, and in the intervals he drank very freely of barley

water.

Having persevered in this way for ten days without receiving any benefit, he was induced to make a trial of magnesia, of which he took one tea-spoonful night and morning in cold chamomile tea. In about a week, the state of his stomach was much improved, and the deposit in the urine proportionally diminished, and in three weeks every symptom of disease had disappeared.

In February, 1812, having persevered in the use of magnesia with little intermission, I was informed that the sand had returned, that increasing the quantity of magnesia had produced no good effect, and that alkalies materially aggravated his complaint, by disagreeing with the stomach and greatly increasing the urinary deposit.

On examining the sand, I found that instead of consisting as formerly of uric acid, it was composed of a mixture of the