Beverages

When the presence of vesical calculus has been demonstrated it becomes important to regulate the diet so as to prevent, if possible, aggravation of the trouble. Not much is to be hoped from the action of any solvents, such as the alkaline waters or lithia salts, upon a large stone already formed, but diuretics may certainly do much to prevent recurrence of the formation by controlling vesical catarrh, and the production of mucus which forms the nucleus, and sometimes a considerable part of many stones. As White observes: "Our object should then be to make the urine as bland and abundant as possible, and for this purpose there is nothing better than milk and the free use of water between meals. The particular kind of water to be used is of minor importance, as the most noted waters in the treatment of stone seem to have purity as their chief recommendation".

The still spring waters, such as Poland, Londonderry, or Bedford, may be prescribed, or the waters of Vichy, Saratoga, or Ems, on the principle that many patients will drink more fluid which bears the name of some reputed "Spring " than they will if it be plain water.

Paget was fond of trying the effect of an exclusive milk diet before advising lithotomy. The milk is soothing, and while it is a good diuretic, it lessens the desire for frequent micturition which is often such an annoying symptom of vesical stone.

The occurrence of vesical calculus in children is believed by Cadge, White, and others to be directly proportional to the difficulty of getting abundant milk. It is therefore much commoner among the children of the poor. White believes that " diet and regimen, at least in cities, have much more to do with the production of stone than heredity, climate, water, soil, etc".

Young infants should not "be given lime water indefinitely with their milk.

It is best for adults to relinquish the use of alcoholic stimulants, but if this is not feasible light Rhine wine or still Moselle is admissible, especially if neutralised by some alkaline table water (Yeo). Lager beer is not harmful, and a little dry champagne or a light hock or white wine may be taken. All the heavier clarets, Burgundy and sweet wines of every sort, port, sherry, strong beer, ale, porter, and stout are forbidden. Weak tea and coffee may be drunk. Only such beverages should be allowed as contain no free acids and no sugar, and those having the greatest diuretic effect are the best.

Foods

All highly seasoned and irritating articles, like vinegar, pickles, strong condiments, such as mustard, should be rigidly forbidden, as well as anything prone to excite acid dyspepsia.

Among patients who have calculi of various kinds a considerable number are at the same time afflicted with obesity. Such persons must be especially abstemious in regard to the use of fats and sugars. Less corpulent persons may be allowed a little more laxity in this regard.

Other substances to be avoided are puddings made with eggs and sugar, and containing rice, sago, or other farinaceous foods, suet puddings, pastry of all kinds, meat fat, and fat pork.

Bread, oatmeal, hominy, cracked wheat, cornmeal bread, custards, blancmange, boiled fish, and eggs are all admissible.

In many cases total abstinence from animal food for a week or ten days is followed by marked improvement, the patient living meanwhile on green vegetables, salads, and cooked fruits which are not too acid, such as apples, not sweetened, but flavoured with some bland aromatic, like cinnamon, nutmeg, or cloves. In other cases it may not be necessary to withhold meat completely, but it should always be taken in moderation, not more than once a day, and it should be rare, lean, and thoroughly masticated. White meat of chicken may be eaten.

The Carlsbad dietary, in which butter and sugar in all forms are rigidly proscribed, is found to benefit calculus cases even more than the total withdrawal of meat.

The above directions apply to the treatment of most varieties of calculi, and not to any one kind alone.

In elderly people, in whom such disorders are relatively common, the functional elimination of waste from the body is considerably impaired. For such persons, as well as for those who live sedentary lives, it is important to abstain from overeating and especially from the use of animal food in excess.