Some months afterwards I heard that the bleeding had continued for a few weeks longer ; that the child had then seemed in great pain for a day and a night ; but that after this the water had become clear, and had ever since been perfectly free from blood. The nutrition 'had begun to improve immediately upon the change of diet.
There can be little doubt that the hmmaturia in this case was the con sequence of irritation of the kidney by a small angular concretion ; and the pain spoken of was, in all probability, an attack of renal colic, caused by the passage, or attempted passage, of the little calculus down the ure ter. In cases such as this, the concretions must be looked for carefully in the urine passed at, the end of a fit of colic. They are often no larger than a mustard-seed, or even a small pin's head.
.Prognosis.—The occasional appearance of free uric acid in the urine of infants and children is of no consequence whatever. The frequent passage of sandy particles is of greater moment, for in these cases we are justified in fearing the formation of a stone in the bladder. A mere passing hEema turia should not have too much importance attached to it ; for it is prob able that a certain oozing of blood may occur in the kidney, as a con sequence of irritation from small crystalline fragments, which may be afterwards washed away. Repeated haemorrhage from this source is, however, to be regarded with anxiety ; and if there are signs of pain in the renal region preceding or accompanying the flow of blood, we have reason to fear the presence of a calculus, and further ill-consequences are to be anticipated.
Treatment.—The frequent appearance of uric acid crystals, or of sandy deposits, or even the habitual presence of urates in a child's water, should make us inquire very carefully as to the food he takes, and the general conditions under which he is living. Such a child should live plainly. He should take meat once a day with vegetables, and a light custard or batter pudding. For his other meals he should have milk and bread-and butter, with occasionally the yolk of an egg or a little bacon for his break fast. Care should be taken that he does not overload his stomach, and the quantity of farinaceous food he eats should be duly proportioned to his power of digesting it. Sweet things should be given to the child with caution ; and all cakes and biscuits between meals should be strictly for bidden. He should take exercise freely in the open air. His skin should
be kept in good order by complete washing every day, and in the colder months he should be dressed from head to foot in some warm woollen material. Great attention should be paid to the ventilation of his bed room, and in the winter he should 'be dressed and undressed in a well warmed room. In the case of an infant, vigilance should be exercised that the child does not take too large a quantity of food at one time, and that he is not burdened by too much farinaceous matter to his meals. Cleanliness and plenty of fresh air must be always insisted upon.
In addition to the above measures, care should be taken that the patient drinks sufficient fluid to freely dilute the renal secretion. Remembering that a concentrated state of the urine is alone sufficient to give rise to sandy depoSits in the urine, the child should be made to drink half a tum bler of water, fasting, one hour before food, twice a day. This simple precaution, in many cases, will at once put an end to any appearance of sand. An infant may be given thin barley-water from his bottle with the same object.
For medicine, alkalies, such as the citrate of potash, should be given, and the treatment must be continued for several weeks. If haemorrhage occur, perfect rest in bed must be enforced. These cases seldom require styptics, but if thought advisable, a few grains of gallic acid may be given with dilute sulphuric acid twice a day.
If, from attacks of pain or frequent haemorrhages, it becomes evident that the child has a calculus of the kidney, citrate of potash should be given in sufficient doses to keep the urine slightly alkaline ; and this treatment should be persevered with in the hope of dissolving the concre tion, or at any rate of reducing its size sufficiently to enable it to escape by the ureter. If great irritation and pain are produced by the continued presence of the calculus, and the health and strength of the child seem to be seriously affected, the question of nephrotomy should be considered.
In an attack of nepliritic colic, the child should be kept under the in fluence of morphia, and hot fomentations must be applied to the abdomen.