THE diabetes is a frequent and excessive discharge of urine. It is seldom to be met with among young people; but often attacks persons in the decline of life, especially those who follow the more violent employments, or have been hard drinkers in their youth.
CAUSES. - A diabetes is often the consequence of acute diseases, as fevers, fluxes, &c. where the patient has suffered by excessive evacuations; it may also be occasioned by great fatigue, as riding long journies upon a hard-troting horse, carrying heavy burdens, running, &c. It may be brought on by hard drinking, or the use of strong stimulating diuretic medicines, as tincture of cantharides, spirits of turpentine, and such like. It is often the effect of drinking too great quantities of mineral waters. Many imagine that these will do them no service unless they be drank in great quantities, by which mistake it happens that they often occasion worse diseases than those they were intended to cure. In a word, this disease may either proceed from too great a laxity of the organs which secrete the urine, from something that stimulates the kidneys too much, or from a thin dissolved state of the blood, which makes too great a quantity of it run off by the urinary passages.
SYMPTOMS. - In a diabetes, the urine generally exceeds in quantity all the liquid food which the patient takes. It is thin and pale, of a sweetish taste, and an agreeable smell. The patient has a continual thirst, with some degree of fever; his mouth is dry, and he spits frequently a frothy spittle. The strength fails, the appetite decays, and the flesh wastes away till the patient is reduced to skin and bone. There is a heat of the bowels; and frequently the loins, testicles, and feet are swelled.
THIS disease may generally be cured at the beginning; but after it has continued long, the cure becomes very difficult. In drunkards, and very old people, a perfect cure is not to be expected.
REGIMEN. - Every thing that stimulates the urinary passages, or tends to relax the habit, must be avoided. For this reason the patient should live chiefly on solid food. His thirst may be quenched with acids; as sorrel, juice of lemon, or vinegar. The mucilaginous vegetables, as rice, sago, and salop, with milk, are the most proper food. Of animal substances, shell-fish are to be preferred; as oysters, crabs, &c.
THE drink may be Bristol-water. When that cannot be obtained, lime-water, in which a due proportion of oak-bark has been macerated, may be used. The white decoction, see Appendix, White Decoction, with isinglass dissolved in it, is likewise a very proper drink.
THE patient ought daily to take exercise, but it should be so gentle as not to fatigue him. He should lie upon a hard bed or matrass. Nothing hurts the kidneys more than lying too soft. A warm dry air, the use of the flesh-brush, and every thing that promotes perspiration, is of service. For this reason the patient ought to wear flannel next his skin. A large strengthening plaster may be applied to the back; or, what will answer better, a great part of the body may be wrapt in plaster.
MEDICINE. - Gentle purges, if the patient be not too much weakened by the disease, have a good effect. They may consist of rhubarb, with cardamom seeds, or any other spiceries, infused in wine, and may be taken in such quantity as to keep the body gently open.
THE patient must next have recourse to astringents and corroborants. Half a drachm of powder, made of equal parts of allum and the inspissated juice commonly called Terra Japonica, may be taken four times a-day, or oftener if the stomach will bear it. The allum must first be melted in a crucible; afterwards they may both be pounded together. Along with every dose of this powder the patient may take a tea-cupful of the tincture of roses; see Appendix, Tincture of Roses.
IF the patient's stomach cannot bear the allum in substance, whey may be made of it, and taken in the dose of a tea-cupful three or four times a-day. The allum-whey is prepared by boiling two English quarts of milk over a slow fire, with three drachms of allum, till the curd separates.
OPIATES are of service in this disease, even though the patient rests well. They take off spasm and irritation, and at the same time lessen the force of the circulation. Ten or twelve drops of liquid laudanum may be taken in a cup of the patient's drink three or four times a-day.
THE best corroborants which we know are the Peruvian bark and wine. A drachm of bark may be taken in a glass of red port or claret three times a-day. The medicine will be both more efficacious and less disagreeable, if fifteen or twenty drops of the acid elixir of vitriol be added to each dose. Such as cannot take the bark in substance may use the decoction, mixed with an equal quantity of red wine, and sharpened as above.
THERE is a disease pretty incident to labouring people in the decline of life, called an INCONTINENCY of urine. But this is entirely different from a diabetes, as the water passes off involuntarily by drops, and does not exceed the usual quantity. This disease is rather troublesome than dangerous. It is owing to a relaxation of the sphincter of the bIadder, and is often the effect of a palsy. Sometimes it proceeds from hurts, or injuries occasioned by blows, bruises, preternatural labours, &c. Sometimes it is the effect of a fever. It may likewise be occasioned by a long use of strong diuretics, or of stimulating medicines injected into the bladder.
THIS disease may be mitigated by the use of astringent and corroborating medicines, such as have been mentioned above; but we do not remember ever to have seen it cured.
IN an incontinency of urine, from whatever cause, a piece of sponge ought to be worn, or a bladder applied in such a manner as to prevent the urine from galling and excoriating the parts.
IT has already been observed, that a suppression of urine may proceed from various causes; as an inflammation of the kidneys, or bladder; small stones or gravel lodging in the urinary passages, hard faeces lying in the rectum, pregnancy, a spasm or contraction of the neck of the bladder, clotted blood in the bladder itself, a swelling of the haemorrhoidal veins, &c.
SOME of these cases require the catheter, both to remove the obstructing matter, and to draw off the urine; but as this instrument can only be managed with safety by persons skilled in surgery, we shall say nothing further of its use. A Bougee may be used by any cautious hand, and will often succeed better than the catheter.
WE would chiefly recommend, in all obstructions of urine, fomentations and evacuants. Bleeding, as far as the patient's strength will permit, is necessary, especially when there are symptoms of topical inflammation. Bleeding in this case not only abates the fever, by lessening the force of the circulation, but, by relaxing the solids, it takes off the spasm or stricture upon the vessels which occasioned the obstruction.
AFTER bleeding, fomentations must be used. These may either consist of warm water alone, or of decoctions of mild vegetables; as mallows, camomile-flowers, &c. Cloths dipped in these may either be applied to the part affected, or a large bladder filled with the decoction may be kept continually upon it. Some put the herbs themselves into a flannel bag, and apply them to the part, which is far from being a bad method. These continue longer warm than cloths dipped in the decoction, and at the same time keep the part equally moist.
IN all obstructions of urine, the body ought to be kept open. This is not however to be attempted by strong purgatives, but by emollient clysters, or gentle infusions of senna and manna. Clysters in this case not only open the body, but answer the purpose of an internal fomentation, and greatly assist in removing the spasms of the bladder and parts adjacent.
THE food must be light, and taken in small quantities. The drink may be weak broth, or decoctions and infusions of mucilaginous vegetables, as marsh-mallow roots, lime-tree buds, &c. A tea-spoonful of the sweet spirits of nitre, or a drachm of Castile soap, may be frequently put into the patients drink; and, if there be no inflammation, he may drink small gin-punch without acid.
PERSONS subject to a suppression of urine ought to live very temperate. Their diet should be light, and their liquor diluting. They should avoid all acids and austere wines, should take sufficient exercise, lie hard, and avoid study and sedentary occupations.
WHEN small stones are lodged in the kidneys, or discharged along with the urine, the patient is said to be afflicted with the gravel. If one of these stones happens to make a lodgment in the bladder for some time, it accumulates fresh matter, and at length becomes too large to pass off with the urine. In this case the patient is said to have the stone.
CAUSES.-The stone and gravel may be occasioned by high living; the use of strong astringent wines; a sedentary life; lying too hot, soft, or too much on the back; the constant use of water impregnated with earthy or stony particles; aliments of an astringent or windy nature, &c. It may likewise proceed from an hereditary disposition. Persons in the decline of life, and those who have been much afflicted with the gout or rheumatism, are most liable to it.
SYMPTOMS - Small stones or gravel in the kidneys occasion pain in the loins; sickness; vomiting; and sometimes bloody urine. When the stone descends into the ureter, and is too large to pass along with ease, all the above symptoms are increased; the pain extends towards the bladder; the thigh and leg of the affected side are benumbed; the testicles are drawn upwards, and the urine is obstructed.
A STONE in the bladder is known from a pain, at the time, as well as before and after making water; from the urine coming away by drops, or stopping suddenly when it was running in a full stream; by a violent pain in the neck of the bladder upon motion, especlally on horseback, or in a carriage on a rough road; from a white, thick, copious, stinking, mucous sediment in the urine; from an itching in the top of the penis; from bloody urine; from an inclination to go to stool during the discharge of urine; from the patients passing his urine more easily when lying than in an erect posture; from a kind of convulsive motion occasioned by the sharp pain in discharging the last drops of the urine; and lastly, from sounding or searching with the catheter.
REGIMEN. - Persons afflicted with the gravel or stone should avoid aliments of a windy or heating nature, as salt meats, sour fruits, &c. Their diet ought chiefly to consist of such things as tend to promote the secretion of urine, and to keep the body open. Artichokes, asparagus, spinnage, lettuce, parsley, succory, purslane, turnips, potatoes, carrots, and radishes, may be safely eat. Onions, leeks, and cellery are, in this case, reckoned medicinal. The most proper drinks are whey, butter-milk, milk and water, barley-water; decoctions or infusions of the roots of marsh-mallows, parsley, liquorice, or of other mild mucilaginous vegetables, as linseed, lime-tree buds or leaves, &c. If the patient has been accustomed to generous liquors, he may drink small gin punch without acid.
GENTLE exercise is proper; but violent motion is apt to occasion bloody urine. We would therefore advise that it should be taken in moderation. Persons afflicted with gravel often pass a great number of stones after riding on horseback, or in a carriage; but those who have a stone in the bladder are seldom able to bear these kinds of exercise. Where there is a hereditary tendency to this disease, a sedentary life ought never to be indulged. Were people careful, upon the first symptoms of gravel, to observe a proper regimen of diet, and to take sufficient exercise, it might often be carried off, or, at least, prevented from increasing; but if the same course which occasioned the disease be persisted in, it must be aggravated.
MEDICINE. - In what is called a fit of the gravel, which is commonly occasioned by a stone sticking in the ureter or some part of the urinary passages, the patient must be bled, warm fomentations should likewise be applied to the part affected, emollient clysters administered, and diluting mucilaginous liquors drank, &c. The treatment of this case has been fully pointed out under the articles, inflammation of the kidneys and bladder, to which we refer.
DR. WHYTE advises patients who are subject to frequent fits of gravel in the kidneys, but have no stone in the bladder, to drink every morning, two or three hours before breakfast, an English pint of oyster or cockle-shell lime-water. The Doctor very justly observes, that though this quantity might be too small to have any sensible effect in dissolving a stone in the bladder, yet it may very probably prevent its growth.
WHEN a stone formed in the bladder, the Doctor recommends Alicant soap, and oyster or cockle-shell lime-water, see Appendix, Lime-Water, to be taken in the following manner: The patient must swallow every day, in any form that is least disagreeable, an ounce of the internal part of Alicant soap, and drink three or four English pints of oyster or cockle-shell lime-water. The soap is to be divided into three doses; the largest to be taken fasting in the morning early; the second at noon; and the third at seven in the evening; drinking above each dose a large draught of the lime-water; the remainder of which he may take any time betwixt dinner and supper, instead of other liquors.
THE patient should begin with a smaller quantity of the lime-water and soap than that mentioned above; at first an English pint of the former, and three drachms of the latter, may be taken daily. This quantity, however, he may increase by degrees, and ought to persevere in the use of these medicines, especially if he finds any abatement of his complaints, for several months; nay, if the stone be very large, for years. It may likewise be proper for the patient, if he be severely pained, not only to begin with the soap and lime-water in small quantities, but to take the second or third lime-water instead of the first. However, after he has been for some time accustomed to these medicines, he may not only take the first water, but, if he finds he can easily bear it, heighten its dissolving power still more by pouring it a second time on fresh calcined shells.
THE caustic alkali, or soap-lees, is the medicine chiefly in vogue at present for the stone. It is of a very acrid nature, and ought therefore to be given in some gelatinous or mucilaginous liquor; as veal broth, new milk, linseed-tea, a solution of gum-arabic, or a decoction of marsh-mallow roots. The patient must begin with small doses of the lees, as thirty or forty drops, and increase by degrees, as far as the stomach will bear it. The caustic alkali may be prepared by mixing two parts of quick-lime with one of potashes, and suffering them to stand till the lixivium be formed, which must be carefully filtrated before it be used. If the soiution does not happen readily, a small quantity of water may be added to the mixture.
THOUGH the soap-lees and lime-water are the most powerful medicines which have hitherto been discovered for the stone; yet there are some things of a more simple nature, which in certain cases are found to be beneficial, and therefore deserve a trial. An infusion of the seeds of daucus sylvestris, or wild carrot, sweetened with honey, has been found to give considerable ease in cases where the stomach could not bear any thing of an acrid nature. A decoction of raw coffee-berries taken morning and evening, to the quantity of eight or ten ounces, with ten drops of sweet spirit of nitre, has likewise been found very efficacious in bringing away large quantities of earthy matter in flakes. Honey is likewise found to be of considerable service, and may be taken in gruel, or in any other form that is more agreeable.
THE only other medicine which we shall mention is the uva ursi. It has been greatly extolled of late both for the gravel and stone. It seems, however, to be, in all respects, inferior to the soap and lime-water; but it is less disagreeable, and has frequently, to my knowIedge, relieved gravelly complaints. It is generally taken in powder from half a drachm to a whole drachm, two or three times a-day. It may however be taken to the quantity of seven or eight drachms a-day, with great safety and good effect.