English
"When albuminous substances under¬ go bacterial p'utrefaction in the intestine, or are rapidly decomposing in any part of the body, as in the putrid pus of septic peritonitis, or in empyema, indol is formed. Tl^’lien the indol is absorbed, it is oxidized, forming iudoxyl, and the latter combines "svith the preformed potassium sulphate to become the conjugate potassium indoxyl-sulphate, or as it is more commonly termed ‘inclican*. If indican which is itself colorless comes in contact with acids or oxidizing: agents, it is decomposed with the formation of indigo blue. An excessive formation of indican is indicative of abnormal intestinal putrefaction. As a rule, it is usually associated with hypo- chloro-hydria, as hydrochloric acid exerts restrain¬ ing influence on proteolytic bacteria. An excess of indican is found in gastric cancer and perito¬ nitis ) ; the micturition is painful and the urine has the color of turmeric (curcuma has yellowish- brown color ) in 'Iwridra-melia' {choluriain which the urine is yellowish-brown or greenish-yellow due to the presence of bilirubin in the urine. It occurs in many diseases in which an excessive quantity of bile is excreted as bilious remittent fever and part of it appears tmchanged in the urine ); sour odor and sourish taste in ‘aw to- 260 ANCIENT flINBU MEDICINE meha’ ( oxaluria in 'whicli there is a persistent excretion of oxalates. Normally oxalic acid is excreted daily from 0. OlO to 0. 020 gram ( one- sixth to one-third grain ), but exists in combina¬ tion as calcium oxalate, and is held in solution by the acid sodium phosphate of the urine, and when the latter is deficient, the oxalates are precipitated. Oxalic acid is increased by certain foods, as cabbage, rhubarb, tomato, and to a lesser extent by asparagus, spinach, carrots, string beans and celery. Oxalic acid may also result from oxidation of uric acid or an incom] plete oxidation of carbohydrates, in which case the intermediate product is oxaluric acid. A persistent increase in the excretion of oxalates is usually associated with the disorders of the gastro-intestinal tract or neurasthenia) ; the urine is like pressed alkaline water from ( laundry ) cloth, in smell, color, taste and touch in ‘ksara-meha* ( phosphaturia in which a con¬ siderable amount of earthy phosphates mixed with fixed alkali is excreted with the urine. It is found in dyspepsia and neurasthenia. Occa¬ sionally the fixed alkali and the earthly phos¬ phates deposit their sediments in the bladder, and the few whitish drops passed at the end of urination like semen, may be their symptomic DIS3ASES 261 expression. The urine is decidedly alkaline. Normally phosphoric acid is daily excreted from 2 to 3 grams ( 30 to 45 grains ) in combination as alkaline and earthly phosphates, the alkaline salts predominating. It is derived from the food and partly from the decomposition of lecithin and nuclein. The excretion is greatly increased in leucemia, pernicious anemia, nervous dyspepsia and considerably diminished in intermittent malaria, pulmonary tuberculosis with high temperature, typhoid, nephritis, chronic rheumat¬ ism and yellow atrophy of the liver ) ; the urine is like the water of Indian madder {manjis- fjia=rubia munjista, which has bright red color in ^manjistha-meha’ (hemoglobinuria in which the urine contains the blood-coloring matter ^hemoglobin’ and its oxidation product *methemo~ globin’. Hemoglobinuria occurs in cases where there is such an extensive destruction of the erythrocytes that it exceeds the power of the hepatic activity to transform the whole of the liberated hemoglobin into bilirubin, and the excess escapes by way of the kidney with the urine. It is found in pernicious bilious remittent malarial fever, especially after excessive doses of quinine, syphilis, yellow fever and severe form of jaundice) ; and the urine is like the blood in 262 ANCIENT HINDU MEDICINE ^iionita-meha’ {heniaiiiria in which, the red-corpus¬ cles of the blood appear in the urine. It occurs in cases where there is an acute congestion of the kidnej’- and the number of erythrocytes indicates the severity of the lesion. Bloody urine may be voided in leucemia, hemophilia, purpura, and in renal cancer, tuberculosis, abscess and lithiasis). The discharge is like clarified butter in ‘‘mrpi-meha'{i^yiiriahx yx\\\Q\\ tbe pus appears in the urine. It may be due to different causes, but often it is associated with the gonorrheal urethritis. The urine containing the pus from any renal lesion is usually acid and from the bladder alkaline); the urine is fatty in ‘vasa-meha* {lipuria in which the fat is present in tbe urine in such quantities as to enable its identification by the unaided eye. The fat may appear in the urine due to the ingestion of excessive amounts of fat (fat meat, or in cases of fracture involving the bone marrow and causing fat embolism, in long-continued suppurative processes, in the lipemia of diabetes mellitus, from the fatty degeneration of the renal epithelium in chronic nephritis, of pus cells, in pyonephrosis or neoplasm along the urinary tract, or in the fatty degeneration in phosphorus poisoning. If the urine is so crowded with minute fat globules as DISEASES 263 to present a milky appearance to the naked eye, it is called ‘chyluria' or *galactm'ia\ Chyluria is usually due to parasitic origin, especially due to the presence of ‘filaria, sfinguinis hominis’j; the urine is in taste and color like honey-sugar {ksaudra = fruit-sugar, that is levulose) in hsaudra- Wteha’ {leviilosiiria in which levulose appears in the u.’ine. It seems that the pancreas does not re¬ gulate the metabolism of levulose, for when there is intolerance for dextrose as in glycosuria, a good deal of fruit sugar can he assimilated. Pro- lably the liver synthetizes the fruit sugar and in tie severe hepatic lesion or in the presence of bxins in the blood which causes irritation to the nuscles, which possess a considerable power to uilize sugars, levulose is abnormally excreted wth the urine, though its permeability through thi kidney is nearly four times less than that of mdtose); the urine flows like that of a mad ele- ph.nt in ^hasti mehcC {polyuria or the diabetes inspidus in which 10 to 20 quarts of pale urine is ('.scharged daily). SmrutaYl. 6. 10**®. 1^315 ii^® 264 ANCIENT HINDU MEDICINE “Any one who I’epeatedly urinates ink-colored (blackish) warm urine, suffers from ‘kala-meha^ (alkaptonuria in which the urine darkens on standing, due to the presence of alkapton (glycosuric acid) or related oxyacids, or melanin from melanotic cancer; or in hemoglobinuria as in pernicious remittent bilious fever, duo to tte destruction of largo amounts of erythrocytes, the blood-pigment may undergo change and appear in the urine as brownish-black or blackisb, and for this reason the fever is called '‘hlacl- water-fever').^’’ Charaka IT. 4. 17.“’^. Prognosis: “If one has acquired diabetes mellitus {madku-meha) by hereditary transmis sion, he is incurable. It is not only hereditaiy glycosuria that is incurable, but all hereditay ^ct !3ff ^idfirfHTrrsT i gfq':nw iratai i. I 117. ^ I =qKqre’f%ciT; DISEASES 265- predispositions are hard to remedy.” Charaha; YI. 6. 41**'. “As birds easily take shelter in low trees, so glycosuria rapidly attacks those who are addicted to gluttony, but averse to bathing and walking (physical exercise and exertion). Glycosuria proves fatal for one who lacks energy, is very fleshy, fat and extremely corpulent. He who eats only to cover his metabolic needs, recovers his health.” Charaha IT. 4. 32. “If the diabetes lasts for a long time, then there are complications of polydipsia, fever, diarrhoea, hyperaeraia, weakness, anorexia, indi¬ gestion and putrefying boils, abscesses and gangrenes.” Charaka II. 4. 30’'". lis. ^ ^ 119. g i j<3; ’I’^ra ii ’ ^i; % u ^^5iror‘f%ctT, s i 120. utiw 263 ANCIENT HINDU MEDICINE ‘‘If a diabetic has boils then an expert surgeon shall treat him by cleaning and restoring {cicatrizing) them by his instruments. Chaf’aka VI. 6. 42 = b Prophylaxis: In diabetes mellitus, it is neces¬ sary to know whether the disease is aequired or inherited. In lesions affeeting the pons medulla, eerebellura, liver, thyi’oid and especially the pancreas, diabetes may be provoked. But in other diseases which do not seriously damage the pancreas, as in syphilis, acute infection, trau¬ matic and surgical neurasthenia, physical and mental excesses, there usually exists a predis- j)Osing cause. I'lie predisposing cause consists of metabolic deficiency of assimilating carbohy¬ drates. It might lie in some inherent weakness of the liepatic and judncipally the pancreatic cells or that of the organism to burn the carbohy¬ drates or that of the nervous mechanism control¬ ling the process. Susruta did not fail to distin¬ guish them. He says ; 121. fq?^i <!i: nsrararatmi: DISEASES 267 “Diabetes is either inherited or acquired (alimentary). Inherited diabetes is due to improper dietary. The hereditary diabetic is very lean, dry (skin), lias weak appetite (anorexia)^ polydipsia and is very nervous ; the alimentary diabetic is fleshy, has voracious appetite {Jjulimia), adiposis and is addicted to sedentary habits (fond of bed, seat and sleep. The lean diabetic should be treated by dietetic regulation, and the fat diabetic by * opatm'pana' (exercise and fasting). Su&ruta IV. 11. 2*“". Prophylaxis should begin vrith children, especially when children of hereditarily predis¬ posed parents are found with tendencies to neurosis, gout or obesity, .