Of all the purging medicines the oleum ricini is to be preferred in calculous disorders; whether a stone, orother cause of inflammation, produces gravelly symptoms. To relax the passage for the calculus to pass from the kidneys to the bladder, this oil is preferable to any other known medicines, either by the mouth or clyster. Oil, manna with nitre, or vitriolated magnesia with the oil of almonds, may be used in its stead; for they empty the intestines, take off all pressure upon the ureters, moderate the heat of the body, lessen, the inflammation, and relax the spasm which the pain occasions. If the ol. ricini is taken in the fit, so as to keep the belly lax, and the aqua kali puri at proper intervals, mixed in any suitable vehicle, their efficacy in calculous disorders will equal that of the most boasted remedies used in these cases. In slighter attacks, a mixture of soap four parts, and rhubarb one part, twice a day, in doses sufficient for keeping the bowels easy, will be sufficient.

The use of clusters is singularly beneficial. The colon forms an arch over both the kidneys, is sometimes joined to the left; and, consequently, a warm emollient decoction thrown up, may, by its heat and moist vapour, relax and soften the kidney like a fomentation.

Hence we see why flatulent or other accumulations usually occasion a fresh fit; and why the left kidney is more subject to complaints than the right. The ol. ricini is peculiarly useful in emollient clysters; but turpentine should make no part of their composition. Two drachms of the tinctura opii may be thrown up, after the operation of the laxative clyster, when the pain is great.

When the vomiting abates, the stomach and bowels-are freed from their contents; then it is proper to give opiates, which, by easing the pain, and relaxing the spasm, most effectually open a passage. Their repetition can only be determined by the attending physician. When the pain is of very long continuance, and accompanied with great prostration of strength, especially if these occur in advanced age, and with a weak state of the pulse, Hoffman forbids the use of opiates, as of a poison; and says that, in such cases, gentle cordial waters, as those of mint, balm, and cinnamon, with the addition of a few grains of saffron, and the moderate use of wine, are the best means of supporting nature. Yet, if the loss of strength is caused by the violence of the pain alone, opiates will be necessary.

The semicupium is an useful assistant when the pain is violent, for it powerfully relieves the stricture of the part. After sitting a sufficient tune in it, ten or twenty of the soap pills may be taken.

Vomiting is sometimes a troublesome symptom; but if not very severe, it is rather useful, and ought not to be suddenly checked. Whilst moderate, it rather prevents the cohesion of the gravel, and promotes its expulsion. When it is necessary to remedy this complaint, the patient may drink freely of some warm aqueous liquor to unload the stomach of its contents; and the saline draught in the act of fermentation, followed by an opiate, may be given.

If a stone stick in the kidney, or the ureter, stimulating medicines are unsafe, and diluents are thrown up without producing any advantage; but when the anodynes have considerably abated the spasms, when the pulse is grown calm and soft, and the whole body is of a moist and equal heat, then the expulsion of the stone or gravel may be expected, often without further assistance.

Bloody urine is sometimes a symptom attending the gravel, in which case a dose of manna may be taken as a purge, in a quart of milk whey, at several draughts. (See Wallis's Sydenham.) To quicken itsoperation, and render it easier in the stomach, a slice of lemon may now and then be sucked. This may be repeated every day, or every other day, for it both eases the pain and moderates the discharge of blood. After its operation, a dose of opium may be taken at bed time. If the bloody urine is from the bladder, and attended with spasms there, or an ulcer, warm external applications are useful just above the pubes.

When calculous complaints attend during pregnancy, which very seldom happens if the pain is violent, a slight bleeding may be admitted, with oily-laxatives, and afterwards opiates. If a stone is perceived in the bladder,it should be extracted before pregnancy; but if the woman is already pregnant, we should wait until her delivery. During the time of labour, the stone should be pushed and kept up above the child's head, if possible; if this cannot be done, the assistant must pass up his hand as soon as the os internum is sufficiently dilated, and, breaking the membranes, turn the child, and bring it away by the feet. There will then be room for the stone to be raised by the catheter, to prevent the child's head from pressing it against the urethra, which would give the woman great pain, and perhaps lacerate the parts.

See Boerhaave, Aretaeus, Alexander Trallian, Lom-mius, Hoffman, Wallis's Sydenham. Lobb on the Stone and Gout. Medical Museum, vol. i. and iii. Bell's Surgery, vol. ii. 9, etc. White's Surgery, 348. Memoirs of the Medical Society, vol. i. 225.

A stone is sometimes forced from the bladder into the urethra, and sometimes it is generated in this passage. Boerhaave observes, that if recent urine be placed in a heat no greater than that of a healthy man, it soon throws off a stony matter to the sides of the vessels; a calculous matter, by too long a detention of this fluid in the bladder, may therefore be soon and easily formed; and a little of it may on its passage with the urine be so entangled in the urethra, as not readily to be extricated, but become the basis of a larger stone. Mr. Warner observes, that the urethra, in cases of this kind, becomes a cyst, which acquires a great degree of hardness, remaining compact and whole till an inflammation is produced by its no longer admitting any further distention. The inflammation is then soon communicated to the teguments, by which means they become painfully tender, and are easily lacerated.