Part 22
Diagnosis.--Examine the urine often in pregnancy, scarlet fever, etc., and especially when watery swelling is noticed.
Recovery.--The result in your children when it comes with scarlet fever is not so good. It may run into chronic nephritis. In adults when it is due to exposure the rule is recovery.
Treatment.--The patient must be kept in bed until there is complete recovery. He should be clothed in flannel.
Diet and Nursing.--This must be of milk, water or mineral water in large quantities; milk or buttermilk should be the main article of food. You can give gruels made of arrowroot or oatmeal, barley water, beef tea and chicken broth. But it is better to stick strictly to milk. As the patient gets better, bread and butter, lettuce, watercress, grapes, oranges, and other fruits may be given. The return to a meat diet should be gradual. The patient should drink freely of mineral waters, ordinary water or lemonade, these keep the kidneys flushed and wash out the "debris" from the tubes. One dram of cream of tartar in a pint of boiling water, add the juice of half a lemon and a little sugar; this when taken cold is a pleasant satisfactory diluting drink. Cream of tartar one dram, juice of lemon, sugar sufficient, water one pint, may be given whenever desired. There should be hot water baths daily or oftener; or you can produce sweating by placing hot water jars around the patient, and watch to see whether it is too weakening. It can also be done by introducing steam underneath the bedding, that is then lifted a little, so that the steam vapor can circulate about the patient. Be careful not to burn the patient with the hot steam. This, of course, is done through a hose attached to a steaming kettle. Also see treatment of dropsy under "scarlet fever."
Bowels, Attention to.--They should be moved every morning by a saline (salt) cathartic, if necessary, especially if the dropsy continues. This produces watery stool. Cream of tartar and epsom salts, equal parts, is good remedy; one-half teaspoonful every three hours for a child one year old until the bowels move freely; one-half to one ounce can be given to an adult.
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CHRONIC BRIGHT'S DISEASE. (Chronic Parenchymatous Nephritis. Chronic Diffuse Desquamative or Tubal Nephritis. Chronic Diffuse Nephritis with Exudation). Causes.--Young adult life and most common in males. It may come from acute inflammation of the kidneys that was due to exposure, pregnancy, or scarlet fever, or follow excessive use of alcohol, etc. In children it usually follows acute inflammation of the kidneys or scarlet fever.
Condition.--The kidneys may be enlarged, with thin capsule, white surface, cortex thickened and yellowish, or whitish (large white kidney). The epithelium of the tubules is granular, or fatty or the tubules are distended and contain casts. Cells of the "Glomeruli" and their capsules are swollen. There is moderate increase of interstitial tissue. In other cases, the "small white kidney," the kidney is small and pale either at first or as a later stage of the large white kidney. The surface is pale, rough and granular; the capsule is thickened and partially adherent; the surface is thin with white and yellowish areas of fatty degenerations. The interstitial tissue is much increased; epithelial degeneration in the tubules extensive. There is also the large red kidney, and with any of these types the left heart may be enlarged and the arteries thickened.
Symptoms.--If it occurs after acute nephritis the symptoms of acute nephritis subside, but anemia and the changes in the urine persist. Usually there is a gradual onset with paleness and puffiness of the eyelids, ankles or hands in the morning. Later there is difficult breathing, increased watery swelling of the face, extremities and dependent portions of the body; worse in the morning. There is a pasty yellowish pallor, afterwards dropsy of the abdominal and chest cavities. The urine is diminished, high colored, specific gravity usually 1020 to 1025 with much albumin. Many casts which are named hyaline, granular, epithelial and fatty. The action of the heart is bad. There may be trouble with the stomach and bowels, constipated, etc. The digestion is poor and the patient frequently suffers with much gas. Recovery is rare after it has lasted one year.
Treatment. Diet.--Milk or buttermilk should be the main article of food. You can give gruels made of arrowroot or oatmeal, barley water, beef tea, and chicken broth, but it is better to keep strictly to milk. As the patient gets better, bread and butter, lettuce, watercress, grapes, oranges and other fruits may be given. The return to the meat diet should be gradual. The patient should drink freely of mineral water, ordinary water, or lemonade. These keep the kidneys flushed and wash out the "debris" from the tubes. One dram (teaspoonful) of cream of tartar in a pint of boiling water, add the juice of a half a lemon and a little sugar. This when taken cold is a pleasant, satisfactory drink. Medical treatment is not satisfactory. The only thing to do is to give medicines to meet the indications; fifteen to twenty grain doses of lactate of strontium. Diuretin also is used. Basham's mixture for anemia is of help in some cases. It can be bought at any drug store.
[KIDNEY AND BLADDER 159]
CHRONIC INTERSTITIAL NEPHRITIS. (Sclerosis or Cirrhosis of the Kidneys. Granular, Contracted or Gouty Kidney).--This is met with, (a) as a sequence of the large white kidneys forming the so-called pale granular or secondary contracted kidney; (b) as an independent primary affection; as a sequence of arterio-sclerosis.
Causes.--The primary form is chronic from the onset, and is a slow creeping degeneration of the kidney substance, and in many respects an anticipation of the gradual changes which take place in the organ in extreme old age. Families in which the arteries tend to degenerate early are more prone to this disease. Doctor Osler says: "Among the better classes in this country Bright's disease is very common and is caused more frequently by over-eating than by excesses in alcohol."
Arterio-Sclerotic Form.--This is the most common form in this country, and is secondary to arterio-sclerosis. The kidneys are not much, if at all, contracted; very hard, red and show patches of surface atrophy. It is seen in men over forty who have worked hard, eaten freely, and taken alcohol to excess. They are conspicuous victims of the "strenuous life," the incessant tension of which is felt first in the arteries. After forty, in men of this class, nothing is more salutary than to experience the shock brought on by the knowledge of albumin and cast tubes in the urine.
Symptoms.--Perhaps a majority of the cases are latent (hidden) and are not recognized until the occurrence of one of the serious and fatal complications. There may have been no symptoms to suggest to the patient the existence of a dangerous malady. In other cases the general health is disturbed. The patient is tired, sleepless; he must get up two or three times at night to pass urine; the digestion is disordered, the tongue is coated; the patient complains of a headache, failing sight, and gets out of breath by exercising. There may be vomiting, headache, neuralgia, and increase of the quantity of urine is common. This is light in color, of low specific gravity, 1005 to 1012; frequently there is a trace of albumin and a few casts of the hyaline and granular kind. In the late stages the albumin may be increased with high specific gravity and a less quantity of urine. The disease often lasts for a year.
In the arterio-sclerotic variety the urine may be normal or diminished in quantity, specific gravity normal or increased, the casts are more numerous, and the albumin is usually more abundant. There is an enlargement of the heart; the pulse is increased in tension; the wall of the artery is thickened. The skin is usually dry, with eczema common, but dropsy is rare, except when it is due to heart failure. There may be bronchial and lung troubles; attacks of uraemia, or hard breathing caused by the heart, frequently occurs. There may be hemorrhage of the brain or hemorrhage of the membranes, and these are often fatal.
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Recovery.--Chances are unfavorable, but life may be prolonged for years, especially with care and especially if it is discovered early.
Treatment.--A quiet life without mental worry, with gentle but not excessive exercise, and residence in a climate that is not changeable should be recommended. A business man must give up his worry; his rush; his hurried eating, and rest. The bowels should be kept regular; there should be a tepid water bath daily, and the kidneys should be kept acting freely by drinking daily a definite amount of either distilled water or some pleasant mineral water. Alcohol, tobacco, excessive eating and improper food must not be allowed. Weak tea and coffee may be allowed. The diet should be light and nourishing. Meat should not be taken more than once a day. If it is possible, the patient should be urged to move to a warm equable climate during the winter months, from November to April, like that of southern California. Medicines must be given to meet the indications. No special directions can be given. The heart, stomach, and bowels must be watched.
DIET as Allowed by a Prominent Hospital.--
May Take:--
Soups.--Broths with rice or barley, vegetable or fish soup.
Fish.--Boiled or broiled fresh fish, raw oysters, raw clams.
Meats.--Chicken, game, fat bacon, fat ham (sparingly).
Farinaceous.--Hominy, oatmeal, wheaten grits, rice, stale bread, whole wheat bread, toast, milk toast, biscuits, maccaroni.
Vegetables.--Cabbage, spinach, celery, water-cresses, lettuce, mushrooms, mashed potatoes, cauliflower, onions.
Desserts.--Rice and milk puddings, stewed fruits, raw ripe fruits.
Must Not Take:--
Fried fish, pork, corned beef, veal, heavy bread, hashes, stews, battercakes, lamb, beef, mutton, gravies, peas, beans, pastry, ice cream, cakes, coffee, tobacco, malt or spirituous liquors.
[KIDNEY AND BLADDER 161]
PYELITIS.--This is an inflammation of the pelvis of the kidney and may be caused by bacteria from the blood, or by ascending pus, infection or tuberculous infection from the lower tracts like the ureter, bladder and urethra.
Symptoms.--There is pain in the back, with tenderness and pressure, cloudy-looking urine, either acid or alkaline, containing pus, mucus, and sometimes red blood cells; chills, high fever, and sweating occur. This may become chronic and then it becomes quite serious. Anemia and emaciation are then marked. Mild cases usually recover; pus cases may end in other diseases or death from exhaustion.
Treatment. Diet.--In mild cases fluids should be taken freely, particularly the alkaline mineral water to which citrate of potash can be added. Tonics should be given when called for, and milk diet and buttermilk may be taken freely. When a tumor has formed, and even before, it is perceptible, if the symptoms are serious and severe, an operation may be necessary.
KIDNEY STONE. (Renal Calculus. Nephro-Leithiasis).--Forming of a stone or gravel in the kidney or its pelvis may occur in intra uterine, (before the child is born), in the womb, or at any age. A family tendency, sedentary life, excesses in eating and drinking and very acid urine predispose. They vary in size from that of fine sand to that of a bean.
Symptoms.--Patients may pass gravel for years without having an attack of renal (kidney) colic, and a stone may never lodge in the ureter. A person may pass an enormous number of calculi. Dr. Osler speaks of having had a patient who had passed several hundred kidney stones (calculi) with repeated attacks of kidney colic. His collection filled an ounce bottle. A patient may pass a single stone and may never be troubled again. A stone remaining in the kidney may cause dull aching pain in the affected kidney, or the pain may be referred to the other side and sometimes there may be blood or pus in the urine, with chill and fever due to pyelitis. Kidney (renal) colic comes on when a stone enters the ureter, if it is at all large. At attack may set in abruptly, without any apparent reason, or it may follow a strain in lifting. The pain may be agonizing in character, which starts in the flank of the affected side, passes down along the course of the ureter and is felt in the testicle and along the inner side of the thighs. The testicle is drawn back. The pain may also go through the abdomen and chest, and be very severe in the back. In severe attacks nausea and vomiting are present and the patient is collapsed; sweating breaks out in his face and the pulse is feeble and weak. The pain lasts from an hour to several days, until the stone reaches the bladder, partial suppression of the urine during the attack occurs, but a large quantity of urine is usually passed after it and a feeling of soreness may, be present for several days. The stone may again cause pain in passing through the urethra, or it may remain in the bladder as a nucleus for a bladder calculus (stone). Dr. Osler gives Montaigne's description as follows; "Thou art seen to sweat with pain, to look pale and red, to tremble, to vomit well nigh to blood, to suffer strange contortions and convulsions, by starts to let tears drop from thine eyes, to urine thick, black and frightful water, or to have it suppressed by some sharp and craggy stone that cruelly pricks and tears thee."
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Treatment.--Great relief is experienced in the attacks by the hot baths or fomentations which sometimes are able to cause the spasm to relax. If the pain is very severe morphine should be given by the hypodermic method and inhalations of chloroform given until morphine has had time to act. Local applications are sometimes grateful,--hot poultices or cloths wrung out of hot water may be helpful. Cloths wrung out of steaming hop, wormwood, or smartweed teas, are of benefit sometimes. Change of position often gives relief; when the stone is large an operation may be needed. The patient should drink freely of hot lemonade, soda water, barley water. When the patient is free from the attack, he should live a quiet life and avoid sudden exertion of all kinds. There should be a free passage of urine always. The patient should drink daily a large but definite quantity of mineral, or distilled water which is just as satisfactory. You may take the citrate or bicarbonate of potash. Mineral springs are good to visit, such as Saratoga, Hot Springs, Arkansas, etc. Abstain from alcohol and eat moderately. Live an open-air life with plenty of exercise and regular hours. The skin should be kept active; a cold friction bath in the morning is good, if one is strong; but if he is weak and debilitated the evening warm bath should be substituted. The patient should dress warmly, avoid rapid alterations in temperature, and be careful not to allow the skin to become suddenly chilled.
Diet.--Most persons over forty eat too much. One should take plenty of time to eat, and not too much meat should be eaten.
"Queen of the Meadow."--The Indians used this medicine quite frequently in the treatment of kidney and bladder troubles. A lady, whom I know well, told me that she had a cousin who was affected with the kidney stone colic. At one time, when he was suffering from an attack, an Indian happened in their home and saw him suffering. He went into the meadow and dug some of this remedy and made a tea of it. It seemed to do the work, for while he gave it, the pain was eased and he never had any more attacks. I give this for what it is worth. The remedy will certainly do no harm for it is a good diuretic.
INFLAMMATION OF THE BLADDER. (Cystitis). Causes.--It may occur from injury from passing a catheter, etc., from the use of drugs like cantharides, from the presence of a stone, from stricture of the urethra and from gonorrhea or cold.
Symptoms.--The urine is passed more frequently, sometimes the desire to pass the urine is almost constant. The distress is relieved for only a few minutes by passing the urine; sometimes only a few drops are passed, and it gives no relief from the desire for passing urine. The straining is extremely severe. Sometimes the patient will lean over the vessel quivering with the muscular effort to pass urine. The bowels often move at the same time from the straining. The urine becomes thick with much mucus, then scanty, and then tinged with blood.
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BLADDER TROUBLE. Mothers' Remedies. 1. English Oil of Sandal Wood for.--"Get one ounce of the pure English oil of sandal wood, take four drops three times a day in a little water. As you urinate more freely reduce the dose. This is a splendid remedy."
2. Bladder Trouble, Effective Herb Teas for.--"Make a tea of half ounce of buchu leaves, half ounce of uva ursi leaves (barberry leaves), one pint of boiling water. Dose: Two or three tablespoonfuls three times a day, or may drink quite freely." A tea made of cornsilk is a common and standard remedy.
Treatment.--Remove cause if possible. Fomentations of hops, smartweed, wormwood are good, even hot water over the bladder. Hot hip bath is good, and also the warm foot bath. The bowels should be kept open with saline laxatives. Buchu tea is very good. Use about one-half ounce of the leaves to a pint of warm water and let it steep, not boil. Drink freely of this. Pumpkin seed tea or watermelon seed tea is good, also flaxseed tea. Dr. Hare recommends the following at the beginning if there is fever:
Tincture of Aconite 3 drams Sweet Spirits of Nitre 1 ounce Solution of Citrate of Potash enough to make 6 ounces
Mix.
Give a dessertspoonful every four hours until all fever ceases and the pulse is quiet. The patient should be kept quiet.
Diet.--Should be milk only.
CHRONIC INFLAMMATION OF THE BLADDER.--Causes.--It follows repeated attacks; partial retention of urine in the bladder, decomposing there; Bright's disease, inflammation of the urethra, injury, etc.
Treatment.--Wash out the bladder with pure warm water or water containing about one to two teaspoonfuls of boric acid to the pint of warm water. This should be given once or twice a day; or enough permanganate of potash can be put into the water to give the water a tinge of the color. An injection of golden seal, one teaspoonful to the pint of warm water, is good if there is much mucus. The best way to give the irrigation is to attach a small funnel to a soft rubber catheter and fill the bladder by raising the funnel when full of water above the patient's belly; or you can attach the rubber tube of a fountain syringe to a catheter at one end and to a funnel at the other and raise the funnel to the desired height; or you can attach a catheter to the rubber tube of a fountain syringe (clean one) and raise syringe high enough to allow the water to run into the bladder gently. The patient will stand just about so much water. The rubber can then be detached from the catheter and the water allowed to run out.
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DISEASE OF THE PROSTATE GLAND. The prostate, which both in structure and in function is rather a muscle than a gland, is situated at the neck of the bladder and around the first inch of the urethra. It is divided into two lateral (side) lobes (parts) by a deep notch behind and a furrow at the upper and lower surfaces. The so-called middle or third lobe is the portion which is between the two side lobes at the under and posterior part of the gland, just beneath the neck of the bladder. The urethra (the channel for the urine to pass through from the bladder out through the penis) usually passes through the gland at about the junction of its upper and middle third.
HYPERTROPHY OF THE PROSTATE.--This is a general enlargement of the gland in all directions. All the three lobes may enlarge and in about one-third of the men who have passed middle life some enlargement takes place, and in about one-tenth of all men over fifty-five this enlargement becomes of importance in regard to the size. The middle lobe may enlarge so much that it may extend up into the bladder and block the opening into the urethra; the side lobes may compress the urethra into a mere slit, or may lengthen it so that the prostatic portion measures three or four inches, or may twist and distort it so that the most flexible instrument can only be made to pass through it with difficulty.
Symptoms.--The earliest symptom may be increased frequency in passing urine, especially at night. Soon some urine is retained in the bladder, and this may increase so much that only an ounce or two can be passed spontaneously, although the bladder contains one pint or more. The stream of urine is feeble, and will drop perpendicularly towards the feet of the patient. In some cases an inflammation of the prostate and bladder is set up, and then the symptoms felt are very distressing. There is an almost constant desire to pass urine; there is much pain and straining with it; a slight bleeding may follow and night rest is broken; the general strength fails from the continual suffering; the urine becomes foul, smells like ammonia, and is reduced in quantity; inflammation of the kidneys develops also; general poisoning occurs; and the patient dies of uraemia and in a "coma" condition.
Treatment. Preventive.--The patient should avoid taking cold in this disease. Light and easily digested diet is necessary. The bowels must be kept regular. Alcohol of any kind should not be used. The bladder should be emptied at regular intervals. Some patients keep a catheter and "draw" their own urine. Unless the patient takes great care, the bladder and urethra will be irritated and perhaps infected through neglect of cleanliness. Medicines are not very useful in severe cases. Operation is the only reliable cure especially when some urine is always retained.
URINARY PASSAGE. Mother's Remedy.--1. Dandelion Root Will Clean.--"A decoction made of the sliced root of dandelion in white wine is very effectual for cleansing and healing inward ulcers in the urinary passage. If the fresh root cannot be obtained, buy extract of dandelion and give two teaspoonfuls in water once in two or three hours as the case requires. It also acts on the liver, gall and spleen."
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DROPSY.--Dropsy should be regarded as a symptom, which may arise from many causes, such as heart disease, lung disease or kidney disease, or it may depend upon obstruction to the normal flow of blood and lymph through the vessels and tissues.
From Heart Disease.--In heart disease dropsy is due to a weak heart. The heart is unable to supply the arteries with enough blood to maintain the normal pressure, or to damming up of blood in the venous system as the result of imperfect emptying of the heart cavities. In kidney trouble the dropsy depends more on the lack of proper nourishing processes in the capillary walls and upon changes in the blood and blood pressure. If the kidneys are diseased, they may not be able to eliminate the proper amount of liquids which accumulate and finally escape into the tissues. Liver troubles cause dropsy by producing pressure upon the large blood-vessels going to the liver, and consequently the fluid is generally confined to the lower limbs and abdomen.
MOTHERS' REMEDIES. Dropsy, 1. Juniper Berries Fresh or Dry for.--"The berries of the juniper tree are regarded as excellent home remedies in dropsy. They may be eaten fresh or dry, or make a decoction and drink. Two teaspoonfuls of the berries two or three times a day is considered a dose. It is well to bruise them thoroughly by breaking the seeds with a hammer before taking." The decoction is more effective. This helps the dropsy by acting on the kidneys.