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and they should not intermarry with families of the same diathesis, nor over-indulge in sugars or excess of carbohy¬ drates. Adults with hereditary tendencies should avoid taking sugar and should not exceed in the carbohydrate diet beyond the physiologic 122. I era 1 I civt; n: I t^'si: nittra I era ^rraq qi- 268 ANCIENT HINDU MEDICINE and metabolic needs. Rather it would be wise to partly replace tlie carbohydrates with fat and protein. Tendency to obesity should be com¬ batted by regular exercise and frugal diet. When obesity has developed, it should be reduced by a slow process of moderate daily outdoor exercise and a slight undernutrition, especially in car¬ bohydrates and fat. Treatment : Glycosuria can be successfully fought only by rational dietary. It is a safe policy in tlie beginning of the treatment to eliminate all carbohydrates from the diet. It may be said against this, that the excretion of sugar in the urine is but a symptom of the lesion, and the elimination of the sugar can not remedy the cause of the lesion, and moreover even in a sugar- free diet, sugar is synthetically prepared and excreted out of the protein and fat molecules. This may be all true, but the clinical experience shows that in a sugar-free diet, the patient soon develops carbohydrate tolerance. And the presence of an excessive quantity of sugar in the circulation and tissues Avhich can not be meta¬ bolized, causes various pathological changes and manifestations. Von Noorden finds the use of oatmeal gruel once a week proves very benefi¬ cial. But on the oatmeal day he forbids the DISEASES 269 -use of any protein, even not egg or milk. Only a little butter is permitted. And the day be¬ fore the oatmeal diet, be gives only vegetables and fat. Levine finds that potato is just as eflicacious as the oatmeal. Fruits containing minimum of glucose like the lemon and orange can be given, as there is certain tolerance for levulose. The alternating constipation and diarrhoea which is symptomatic of diabetes due to srastro-intestinal disorders, should be remedied by laxative and constipative food according to the needs. Strong purgatives should be avoided. If this is not sufficient, in constipation Carlsbad or Epsom salts can be given and in diarrhoea irrigation should be applied. Special attention should be given to the cleanliness of the skin as many skin lesions are apt to take place in glycosuria. Mild antiseptic neutral soaps, con¬ taining tar, boric acid or eucalyptus have proved beneficial. When an infective process has already begun, great care should be taken that the surrounding tissues or other parts do not [ become infected and for local use, iodoform, iodol or aristol can be used with advantage. Diabetes insipidus : The pathology of this disease is not yet well understood. It occurs in cases where there is lesion in the pons. 270 ANCIENT HINDU MEDICINE medulla or the cerebellum. It may be caused by many diseases, but syphilis is tiie principal cause. And in that case its principal remedy is antisyphilic treatment. IV.—Diseases of the Bladder. “There are twelve kinds of lesions of the bladder as follows :—annular swelling {vUta~ kundalika-=pericystis ), -diard globular tumor (mUtrast/dld =• myoma), swelling o[ the mouth of the bladder {vdtavasti—prostatic hypertrophy), difficult and scanty repeated urination {mTdrcdUa — vesical tenesmus ), abdominal bladder ( mldrcx' = over-distension and hypertrophy of the bladder with contraction and obstruction of the cavity), obstruction to the passage of urine {midrotsahga = urethritis), tiremia {mTdra-ksaya'), fibroma {inTdra-granthi), spermatorrhea {nudra- siikra), cystitis (usya-vata) and gangrenous or suppurative cystitis {piTdraiikasada). “If the urine is concentrated and is not eva¬ cuated (in time), the humor ‘vaytC becomes vitia¬ ted and it circulates at the mouth in circular form (that is causes annular infiammation). This causes much pain and there is repeated painful scanty micturition. This difficult disease DISEASES 271 ' is known as *vata-hiindalih(i {pericystitis, which implies inflammation of tlie tunica advenitia of :)lie bladder. Inflammation of the bladder {cystitis) may be provoked by various causes as follows : {a) Cystitis may occur during the course of many acute infectious diseases as acute arti¬ cular rheumatism, typhoid fever, small-pox, measles, influenza, cholera, diphtheria. This complication may set in during the height of the disease, or may appear 'during convalescence. Toward its cause, a number of factors probably contribute. The chemical constituents of the urine are often profoundly altered : the urine is concentrated; it contains abnormal substances of disturbedmetabolism whichare move or less irritant and moreover may contain the pathogenic germs of specific infections. The tissues of the bladder are deprived of proper nutrition and lack their full power of resistance, (b) In constitutional ' diseases as gout and diabetes in which the urine is irritant, (c) In general septicemia as pyemia or internal suppuration of any organ in which the suppuration foci may be brought to the bladder, (d) Erom irritating food and drink as excessive consumption of strong and irritant pepper and alcoholic drinks, (e) Infections from the adjacent organs as the kidney and the ■272 ANCIENT HINDU MEDICINE urethra. The bladder may be affected by the kidney either directly by the urine, or by the lymph channel or by contiguity of the tissues. Urethritis is a common cause of which gonorrhea is an important factor. In acute gonorrhea the passage of gonococci is favored through spincter vesicae in its ascent during vesical congestion under sexual excitement or under the stimulation of alcohol or irritating spicy food. Chronic prostatic hypertrophy is also often a causative factor of the congestion of the base of the bladder. The cystites are of two kinds—simple aseptic and septic. The simple aseptic inflammation may be provoked by the irritating substances in the urine, metabolic or ingested, by the distui’bances in the function of micturition or by the disturbances in the circulation incident to vascular or nervous conditions. It is well known tliat ammonia, oxalates, urates and sugar, if they are concen¬ trated in the urine are active irritants of the bladder. And tlie primary role of the irritants can be asci’ibed to the uric acid sands and calculi. They by their mechanical irritation cause con¬ gestion and inflammation and if the patho¬ genic germs are present, ulcerous gangrenes. Disturbances in the functions of the urine DISEASES 27S; cause moi’e or less hyperemia and inflammation., Over-distension of the bladder either voluntary or pathological, the too frequent and too forceful contractions in the act of urination bring about this condition. When the causes of the over¬ distension, retention and obstruction are organic, septic infection takes place. Various micro¬ organisms have been found to be related with the suppurative process as the staphylococcus pyogenes aureus, albus and citreus which can decompose urea, streptococcus pyogenes, bacteri¬ um coli, proteus vulgaris (which possesses the power of decomposing urea with the production of ammoniacal reaction), gonococcus and tubercle bacillus. ‘‘Unusual frequency of micturition is present in all cases, except in the beginning and in mild cases when the urine remains acid. The causes of frequency are threefold. The reflex influences of an inflammation of the vesical mucous membrane are alone able to provoke frequent urination. In an analogous manner, the irritation of aramonia- cal urine and of precipitated salts effects contrac¬ tion of the organ. In cases of obstruction, the partial retention of the irritant urine powerfully excites the detrusors. Thus the condition of the frequent micturition is usually worse in the 18 274 ANCIENT HINDU MEDICINE contracted bladder of prostatic obstruction. In Ciilculous cystitis, violent movement usually aggravates the condition. Tenesmus is frequent¬ ly present. In some cases it becomes so ex¬ aggerated and remains almost constant, that the patient in order to get relief from the exasperat¬ ing pain, constantly attempts to urinate, to force a few drops, though the bladder may be almost empty). “‘Vayu' causes in the intermediate region of the lower intestine and the bladder, a hard, immovable and tough tumor. This causes the obstruction of the passage of the feces, urine and intestinal gas. This provokes tympanitis and pain. This (disease) is known as *vMasthlW {myoma is usually a hard interstitial tumor, producing a globular induration of the bladder wall. It is generally located at the orifice of the bladder, and it has been noted from the size of a cherry up to such dimension as fill half of the cavity. The tumor is divided into lobules bv connective tissue ; its main bulk is composed of unstriped muscle-cells, in some places arranged in fasciculi, in others irregularly grouped). “In any one who retains urine, the ‘vayu* of the bladder becomes vitiated and closes the mouth of DISEASES 275 the bladder, and consequently the urine is •^obstructed. And this vitiated ‘vayu' remains in the bladder and the prostrate {huksi = groin) as an oppressor (in intumescence). This disease is very hard to cure and it is called *vata-vasti' {obstructive hypertrophy of the prostate which may range in size from an orange to that of a cocoanut.