Calculus Disease calls for a liberal use of water, excepting temporarily in conditions of obstruction of the passage. If the obstruction is more than transient, operation is urgently indicated.

Occurring in acid urine are calculi of uric acid, urates or both and of oxalate of lime. The former are due to the excessive ingestion or formation within the body of purins and it is yet too soon to discard the old belief that excess of protein also has this tendency. Aside from avoiding the dietetic causes, the prophylaxis and treatment (so far as the latter is of avail) consist in the use of water and fruits or alkalies to render the urine slightly alkaline or at most weakly acid.

Calcium oxalate is mainly formed in the urine by fermentation after voiding. However, oxalic acid is normally eliminated up to 2 centigrams a day and it is increased in diabetes, organic diseases of the liver and conditions of suboxidation generally. Apparently, it is formed in the intestine and in excess in various forms of dyspepsia, particularly intestinal dyspepsia following hypochlorhydria. It may be formed chemically from almost any organic food and there is a dispute whether it is more likely to be produced in the intestine in excess on a starchy and sacchar-rine diet or on one rich in proteins.

Klemperer holds that calcium oxalate cannot be precipitated from the urine unless the magnesium oxid falls below 2 parts in 10,000 and the lime exceeds this proportion. The former requisite is maintained by administering small doses of magnesium salts, the latter by avoiding excess of spinach, fresh vegetables generally, milk and eggs but, obviously there are usually contrary indications which require the fairly liberal use of one or more of this group.

Vegetables especially rich in oxalic acid and hence to be avoided are: sorrel, rhubarb, tomatoes, asparagus, spinach, onions, cabbage, some grapes and apples.

In alkaline urine, there are two types of calculus; the phos-phatic consisting of calcium phosphate, with ammonio-magne-sium phosphate if there is ammoniacal decomposition, and the carbonatic, consisting of calcium carbonate with small amounts of magnesium carbonate. Both are prevented by keeping the urine acid and the latter rarely develops except in herbivorae - in man only when the diet is excessively rich in fruits containing vegetable acids which decompose with formation of carbonates.

Even in ammoniacal decomposition, the urine is usually quite promptly rendered acid by the administration of ammonium benzoate. Cranberries, which naturally violate the Pure Food Law by their high content of benzoic acid, may be employed. By minimizing the use of fruits and juicy vegetables and increasing the amount of protein, especially meat, a sufficient urinary acidity can be maintained.

Very rare urinary calculi are composed of cystin, indigo, urostealith and xanthin. The first two are due to excessive intestinal putrefaction whose dietetic prophylaxis and treatment are considered elsewhere. Causs claims that contaminated water may contain notable amounts of cystin, 3 milligrams per liter in the Rhone, 3 centigrams per liter in a well contaminated with typhoid discharges.

Urostealiths are soaps of magnesium and calcium and, as the metals are always present in the urine, the essential cause is fatty degeneration in the urinary passages or possibly the elimination of fatty acids in fat necrosis and fatty acid intoxication. Except in a very recondite degree, the former is not amenable to dietetic prophylaxis or treatment and the dietetic relations of the latter two are considered elsewhere.

Gonorrhoea. It is probably a conservative statement that many cases could be cured by diet alone, if placed immediately upon a bland, semi-liquid diet, free from purins, oxalate-contain-ing vegetables etc., and with sufficient fruit and alkali to render the urine continuously alkaline.

Priapism and ardor urinae are largely preventable, at least, by such a diet.

In all acute cases, alcohol, tea, coffee, chocolate, animal viscera, spices, more than a minimum amount of meat and salt, as well as all rich, greasy or otherwise indigestible foods, should be excluded. Water and fruit juices, as in orange and lemonade, lime juice etc., should be freely administered and sodium bicarbonate may be given to the extent of a teaspoonful a day.

In order that reflex genito-urinary reflexes due to overful-ness of the bladder may not appear at night, the evening meal should be light and should occur at least three hours before bedtime, and very little liquid should be taken in the evening.

Similar genito-urinary reflexes, often taking the form of Nocturnal Emissions, occur independently of gonorrhoea and are often due to excessive amounts of urine or to urine that is too acid or too highly concentrated. Highly acid urine is not, however, by actual test, found to be so common a cause of such reflexes as is ordinarily supposed. In all such cases, the heartiest meal should be taken about noon and while plenty of water, fruit etc., should be used during the day, as little as possible of these diuretic substances, should be taken in the evening. Too highly seasoned or indigestible foods, alimentary saprophytosis, especially of the form of putrefaction, are also common causes of such reflexes.

Prostatic Hypertrophy and Chronic Cystitis, singly or combined, are especially frequent in elderly or old men and the symptoms are much aggravated and the general health undermined by loss of sleep due to the inability of the bladder to retain a sufficient amount of urine. In other cases, with or without these local lesions, there is a chronic nephritis, in which there is a tendency to an excess of nocturnal over the day urine. In these cases, the dietetic regimen just described is appropriate. Care should be taken, however, that in the endeavor to avoid urinary discomfort, the system is not deprived of water.