One stone may exist or several. They may be present in only one or in both kidneys. No age is exempt from them. They may be present in the kidney of the unborn child.
Symptoms.—Gravel may be formed in the kidney and passed in the urine without any symptoms being present. Stone may be formed also without any manifestation, and its presence may be revealed only when it happens to be disturbed and makes an attempt to escape in the water. On the other hand, the production and passing of gravel may irritate the kidney and occasion pain in the loins, and frequent desire to make water. The pain often extends downwards towards the groin and bladder, in the direction of the ureter, and is increased by exercise, especially by jolting movements such as riding in a carriage produces. Frequently, also, there is soreness during the passing of water, particularly at the end of the urethra. The urine is occasionally bloody, the blood not being in streaks, but intimately mixed with the urine. When a stone of any size attempts to pass down the ureter, the pain becomes acute, and is apt to occur in paroxysms, occa sioning what is called renal colic. It begins suddenly, perhaps rises to intense agony, passes down towards the groin and testicle, which is drawn up (retracted), is accompanied by sick ness and vomiting, the patient being bathed in warm perspiration, and frequently produces fainting and collapse. The attack lasts a vary ing time, sometimes a few hours, sometimes, with periods of relief, for days, and usually ends suddenly, either because the stone has reached the end of the ureter and has dropped into the bladder, or because it has been arrested in its course. The passage of one stone does
not imply permanent relief, since others may form, and lead to other attacks.
Treatment depends on the condition giving rise to the production of stone. Uric acid stone is most common, and depends on a highly acid condition of the urine, so that steps taken to diminish its acidity will be useful. Modera tion in food and drink must be carefully ob served, animal food in excess, highly spiced dishes, and heavy wines being specially avoided. Water, barley-water, milk-and-water, should be used freely to dilute the urine, and alkaline mineral waters, particularly Carlsbad, Fried richshall, and Hunyadi Janos, to reduce the acidity of the urine. Change of air is also of great value. The administration of acetate or citrate of potash, 40 to 50 grains in a wine glassful and a half of water, three or four times daily, is also highly recommended, to be con tinued for some months, but suspended for a time if the urine becomes ammoniacal. If oxalate of lime stone is suspected, keeping the urine dilute by the means mentioned above, avoiding vegetables rich in oxalates, such as rhubarb and sorrel, promoting the action of the skin by exercise and bathing, and the use of the mineral waters already indicated, form the treatment.