The Patient is now in his 79th. Year. When a Young Man he was sometimes troubled with gravelly complaints; but they wore off without the use of any Medecine, and he remained more than Fifty Years free from them.

In the Autumn of 1782, he had a severe Attack accompanied with what was thought to be a Gouty Pain in the Hyp, and down the Thigh of the left Side. Some Means were us’d to bring the suppos’d Gout down into the Foot, by warm Bathing, and a Poultis of Mustard. A Swelling was produc’d in the Foot, but not attened with much Pain there; a considerable Pain still continuing above. He daily voided Gravel Stones the Size of small Pease, took now and then some Decoctions of Herbs and Roots that were prescrib’d him by Friends or Physicians, but persisted constantly in nothing except the Use of Honey at Breakfast instead of or sometimes with Butter on his Bread, he remembring to have heard in the Conversation of Physicians, Honey mentioned as of great Service in Gravelly Cases.

At length the painful Past of the Disorder left him, and no more large Gravel offer’d; but observing Sand constantly in his Urine, he continued the Use of the Honey to the amount of perhaps a Pound per Week; notwithstanding which the Malady return’d in the Autumn of 1783, when he first perceived after going in his Carriage on the Pavements, that he felt Pain and made bloody Water. At times when he was making Water in full Stream, something came and Stopt the Passage; this he suspected to be a small Stone, and he suffered Pain by the Stoppage. He found however by Experience that he could by laying down on his side cause the obstruction to remove and continue the Operation. He now thinks the Stone is grown bigger and heavier as he is sensible of its falling from Side to Side, as he turns in his Bed.

He has made it a Rule for some Months to walk an hour in his Chamber every Night. This Exercise is of service to him in other Respects; but he has observed that if he has emptied his Bladder just before he begins his Walk, the Stone is apt to hurt him, and he makes bloody Water. He therefore of late avoids beginning his Walk, till he supposes the Bladder to be refurnish’d.

His Inclination to make Water is sometimes very sudden and very violent, tho’ the Quantity small.

He feels no Pain, nor is at all sensible of the Existence of the Stone, except when it obstructs his Making Water, or when he is in his Carriage on a Pavement, or on some sudden Motion or Turn of the Body; and he enjoys the Conversation of his Friends or his Books as usual.

Thus if it does not grow worse, it is a Tolerable Malady, and may be supported for the short time he has a Chance of living. And he would chuse to bear with it rather than have Recourse to dangerous or nauseous Remedies.

If therefore no safe and sure Dissolvent of the Stone is yet known, he wishes to be informed whether there is a Regimen proper to be observ’d for preventing its Increase, as he can without Difficulty conform to any Manner of Living that shall be prescrib’d to him.

In the last Attack no large Gravel has offer’d, and much less Sand appear’d in the Urine, whence he suspects that it attaches itself to the Stone. His Urine has however been unusually turbid till lately, when a Fit of the Gout came on, and swell’d both Feet, since which the Urine has been very clear.

From the History of the Case, and the distinct account of the patient’s feelings, we have no doubt that there is a Stone in the Bladder.

Taking into consideration the Time of Life of the Patient, and that the Symptoms are not so urgent as to render Life uncomfortable, we approve much of his resolution not to risk an operation, or any course of Medecine that might endanger his health. What we shall advise therefore, will be such things as may either prevent an increase of the disease, or palliate the most pressing Symptoms.

As the patient has already taken Blackrie’s Lixirium with some advantage; we would advise him to continue it. If it do not offend the stomack, it may be used for any length of time, without prejudice to the general health. It has some power as a Solvent, and if that should prove sufficient to prevent the farther increase of the Stone without at all diminishing it, it may procure great relief; For, the painful effects of a stone in the Bladder, do not depend so much upon the size, as the roughness of it’s Surface, which arises from the constant auretion of new matter. If however, Blackrie’s lixirium should either disagree with the patient, or should cease to produce good effects, there are some other things we would recommend a trial of.

Fixed air has been found to do good in similar cases. The Simplest way of taking it, is to impregnate water with it by means of Dr. Nooth’s Machine. Of the Water so impregnated, one or two pints may be drank in the day; or a larger quantity, if it is found not to overload the Stomach. Seltzer water is no unpleasant vehicle of fixed air. To give it a fair trial, it should be persevered in for some time, at least three or four Weeks.

The Ura Ursi has been found to give considerable relief in cases of Stone in the Bladder. It is to be taken in the quantity of two scruples, in half a pint of an infusion of the same, morning and evening. The infusion is to be made by pouring a pint of boiling Water upon three drackms of the Ura Ursi. This Medecine should also be continued some time; at least a month.

We would advise him to guard against costiveness, as that would aggravate his complaints. A tea spoonful of Linitive Electuary, or Electuarium e Casia, or a table spoonful of Castor oil, taken from time to time as may be needful, will answer this purpose. The patient may indeed make use of any gentle luxative, that he has found from Experience to agree with him.

We would advise him to avoid as much as possible all rough motion; and to continue his walking in his room. When he finds himself obliged to go abroad in a Carraige, it would be worth trying, how far his pain would be abated, by using the same precaution as in walking, that is, to go with his Bladder full.

If the pain in his bladder, bloody Urine, and a frequent desire to make water, should at any time become troublesome, either from the motion of a Carriage, or other cause, we would advise him to make use of Anodyne Clysters to silence those Sumptoms. The Clyster may consist of two ounces of oil, as much water, and forty drops of Landanum, made milk-warm. It will be proper to throw up a common Clyster, of a pint of water gruel, weak broth, or even warm water, before using the Anodyne Clyster; by this precaution the Anodyne Clyster may be longer retained, and will be more effectual.

In his diet, we would advise the patient to avoid salt meals, spirits of all Kinds, pepper, and every thing that is in the smallest degree heating, as they increase the pain in the bladder, and render it more sensible of any irritation from the Stone. With regard to Wine, we would advise him never to exceed that quantity, that habit may have rendered necessary, for the purposes of digestion.

In addition to what we have said of the use of anodyne clysters, we would observe, that they may be employed to prevent the pain in the bladder as well as to relieve it; and that the patient may have recourse to them before riding in his Carriage, as a means of lessening his sufferings; for though we would advise him to avoid every Kind of motion that produces pain in his bladder, yet it may not be always in his power to comply with this Advise.

It is unnecessary to mention particular Articles of diet; we would only observe that Broths of all Kinds are well suited to the patient’s complaint, particularly white Broths, made with Almonds, which are good both for Diet and physick, being of an opening Nature.

I was this morning favoured with your letter accompanied with a case and a consultation upon it; all which I have considered, and do not find, that there is any thing left to me to say, unless that I entirely agree with you, Dr. Watson, and Mr. Hunter in recommending to the gentleman not to think of an operation at such an advanced age, but to trust wholly to the Lixivium, it he can bear it. I suppose he could find no difficulty in taking a tea spoonful night and morning; and if he could take two, it would be more desirable. Exercise can hardly be wanted for health at the age of 79; and it is high time to lay aside all business, which would oblige a man to go out, and use much motion: I wish therefore your patient would confine himself wholly to his house and garden, and avoid all riding in a Carriage. If this cannot wholly be avoided, and a fit should be brought on by the motion, or by any other cause, the best relief will be afforded by the Anodyne Clyster; and if his body be tolerably regular as to stools, I know of nothing further that his complaints require.

I entirely concur in Opinion with the Physicians whom you have consulted respecting Dr. Franklin’s Case that an Operation would not be adviseable. The directions which you have already receivd as to the proper mode of treatment, are so full and Judicious, that I think there is little can be added to them. I have the pleasure of sending you Dr. Plunketts Thesis on Mephilic Air. Tho’ his Experiments do not prove that this Air is a Solvent for the Stone yet they seem to shew that drinking freely of Water impregnated with it will have an Influence in retarding the progress of Calculous Complaints. Whether the Effect is produced by the Water or by the Air may be doubtful. To me it seems probable that it is chiefly to be attributed to the former. And I am the more confirmd in this Opinion because I have found that Mild diuretics are generally useful in Calculous Cases. It is I believe principally owing to its diuretic Quality, that much relief has been had in such Cases by drinking freely of an Infusion of the Seeds of the Wild Carrott. And perhaps the Benifit derived from taking large Quantities of Lime Water or from using Lime Water and Milk for the common drink, is partly to be attributed to the same Cause. It is not however safe for patients advanced in Life to drink very freely of Weal Liquids, unless they be at the same time determind to pass off by the kidneys. With an Intention to promote the Urinary discharge and alleviate the Symptons when the Initition is most troublesome, I generally prescribe mild diuretics, joind with an Anodyne and a gentle Laxative in the following form   Rx

Capt.      ter de die. ex Cyatho. Infusi Lini. The Manna in this Prescription should be increasd or diminished, until its quantity is found to be such as will be just sufficient to keep the Bowels gently open; and the Dose of the Laudanum should be regulated according to the Degree of Pain or to the Effect of Custom upon the Constitution. I am &c.

The Symptoms of the Stone in the Bladder as as follows.

A frequent inclination to make urine, which is passd with pain and difficulty. Tenismus (or a desire to go Stool,) accompanied sometimes with a diarrhea, and distnesion and pain in the region of the Colon; (that is, of the great intestine, which makes a circular arch below the Liver and stomach and is principally situated in the left side of the Abdomen.) A sense of titillation in the glans penis. Thick turbid urine. Spasmodic affections in making water. The urine, after exercise, tinged with blood. Greater facility in making water when the body is placed in particular positions. The urine when it is passing in aful stream, sometimes suddenly stopped. A sense of weight in the Perineum.

When a Stone is passing from the kidney to the bladder by one of the ureters, the pain is encreased, and tends downwards. The patient is easiest, when stooping forwards. The Leg and thigh become torpid. The urine is partly suppressed. A fit of the stone, when the pain is very great, is sometimes accompanied with a symptomatic fever. The mode of treatment proper during the fit, is different from what it should be when the patient is free from it. In the former case, the object is to diminish initation by gentle laxatives, fomentations applied to the Perineum, emollient decotions opiates, and Rest.

During the remission, the object is to dissolve the stone, or render its surface smooth by lithontripties; as caustic alkale, Soap, Lime water, diuretics. But these should not be exhibited at the time of the paronyom, as by their stimulating quality they might increase the irritation. Nitie, and Spiritus. Nitr dulcis, are I think an exception to this rule; because if properly administer’d they do not appear to me to irritate, even when the patient is afflicted with the fit.

The following are the principal authors who have written on the stone in the bladder.

Opinions of some of the Faculty on the case of Dr. Franklin;

Dr. Franklin’s case by himself is inclosed, drawn up when in his 79th. year.