English
The hypertrophy may be general, affecting the whole organ symmetrically or the enlargement is confined within the capsule of the gland and may extend a considerable distance, pushing the capsule and remain only connected with the prostate by a glandular and fibrous tissue. As the internal spincter may be considered as an integral part of the prostate, hence any altei’ation of the structure of the latter would be followed by the interference of the function of the former. In addition, as the prostate is limited in front and below by dense fascia, it tends to grow upward and backward as it hyper¬ trophies, elongating and narrowing or deflecting the urethra, according to whether the enlarge¬ ment is symmetrical or irregular, but always raising the vesical outlet to a higher level than normal. The urine therefore left after each micturition (residual urine) settles at the bottom, causing the formation of calculi by precipitation 276 ANCIENT HINDU MEDICINE and sedimentation of the mineral constituents.. And an early effect of the prostatic hypertrophy is congestion and later inflammation of that portion of the mucous membrane of the bladder in contact with the tumor. The inflammation spreads in time, aggravated by the sluggish venous return. And as the passage of the urine is reduced, the bladder can only be incompletely evacuated and a small quantity at a time by slow dribbling from the distended bladder. And in this condition, the mucous membrane offers but slight resistance to microbic invasion). “If for a long time the urine is retained, then when an attempt is made for its evacuation, there is no micturition, or it appears but slightly. If strained, the urine appears with slight pain and in small quantities. This disease is caused by the suppression of the urine, and is called ‘mutra- Ufa’ {vesical tenesmus). “If the urine is suppressed, it causes distension; . distension vitiates ^vayiC and provokes painful tympanites. This is called ^mutra-jathara* and this disease contracts the downward channel (hypertrophy of the bladder with contraction of the cavity and obstruction of the passage). “In the disease in which the flow of the urine :js interfered with either at the neck of the urethra DISEASES 277 or near the glans penis, or under tenesmus bloody urine appears with pain, or without pain it dribbles little by little, this is known as ‘mutrot- sanga' {urethritis). This disease is caused by a qualified (special) ‘myu’. •'In an emaciated and tired body, ‘pitta’ and ‘vayu’ absorb the urine. It causes hyperemia and pain. This disease is called ‘mutrahsaya' {uremia) This is very troublesome. (Uremia occurs in the course of acute or chronic nephritis, puerperal eclampsia^ some cases of obstructed renal calculus, and occasionally in patients with pronounced vascular changes. The symp¬ toms are general malaise, nausea, vomiting, insomnia, amaurosis, mania, delirium, dyspnea, increased arterial tension. In complete uremia, the patient lives about 10 to 12 days). “The tiny, globular and firm tumor that is formed at the interior part of the neck of the bladder, is called ‘mutra—granthi (fibroma gene¬ rally occurs in the adult and is usually located single upon the base and trigonura. The size is like that of a nut. It may be sessile or predi- culated, hard or soft. The surface is lobulated and covered with normal or inflamed mucous membrane, which may or not be firmly attached to the growth. On section the tumor is white 278 ANCIENT HINDU MEDICINE and glistening, and there may be patches of myxomatous or areas of calcification). This tumor is painful, nonulcerative and narrows the mouth of the bladder. It resembles pain like that of calculus. “If any one indulges in sexual intercourse with full bladder, then the semen is displaced and becomes mixed with urine, and pale watery semen appears just before urination or after it. It is called *mut7'a-mhra' (prostatorrhea). Pitta' becomes vitiated in heavy exercise,.. long journey or exposure to the sun, and mixed with the *vayu' brings about the inflammation of the bladder, urethra and the pelivic region- (sympathetic) and causes discharge. In this yellowish, slightly reddish (pinkish) or pure reddish urine is excreted with tenesmus. This disease is called by the specialists as ‘nma-vMa* (in non-suppurative cystitis, the urine is pale yellow, or according to the extent of bleeding, the color will vary from the faintest pink to a deep dark-red). “The disease in which the urine is excreted with burning sensation, is turbid, dark-brownish and concentrated, and if dried (by the sun or evaporated), leaves a residue like powdered granite, is called the bilious ‘muti'ankasada* DISEASES m (supptirative cystitis, in wliich the uvine is turbid, containing tenacious flocculi of altered pus and there is a large amount of precipitated salts and detritus. On standing, a heavy sediment forms, but the supernatant urine does not become clear. The crystalline sediment consists of a moderate amount of amorphous phosphates, amorphous ammonium urates and large quantities of triple phosphates. The crystals of ammoniun urate are dark balls which may be spiculated; the triple phosphate commonly appears in the form of slab-shaped crystals; there may however, be needles, squares and many forms of irregular crystallization). The disease in which the urine is whitish, concentrat¬ ed and appears with tenesmus, and when dried, it is pale-colored like the conch-shell powder and is slimy, is to be known as phlegmatic ‘mTitratt- Jcasada' ( cystitis and tumor of the bladder in which the urine is pale-whitish, opalescent, with a heavy deposit of pus, phosphates and detritus. It is alkaline in reaction. The benign tumors are in themselves quite compatible with long life: in several carefully observed subjects, they existed, ten, twenty or more years. The course of papilloma is largely determined by the hemor¬ rhage and the complications. The malignant '280 ANCIENT HINDU MEDICINE tumors are usually fatal within one or two years, particularly of the base or the neck. The fatality of the disease of course depends upon the site affected, the variety of growth present, the clinical course, and complications of cystitis and nephritis. The causes of death are indirect. Rarely profuse hemorrhrge has been the direct cause. In the cachectic debility which follows prolonged hemorrhage, the system becomes vulnerhle, and any intercurrent disease may prove fatal). “Charalca'Vl,b9), 2-13^'®. 128 , ^ I ^ ^?iTf 3tf^nwi i ii ?TT^ fejT<T W ^ i cT^pjiTsr^ <s\m^ I %iiT cTT i ^ I f%^f% ^ ^ T DISEASES 281 “In these thirteen kinds of urinary troubles use remedial medicines which will relieve strangury. In all these lesions bougie and irrigations are applicable. The cylinder of the bougie is to be made of ci w < ^qpr: ‘ ^TT^mT ^ ^ I cT ^ J fq^mr^ i 11 < vq ^ 1 ’f I 282 ANCIENT HINDU MEDICINE gold or silver. The aperture of the cylinder made of gold should be like that of the jasmine flower stem, and that of the silver like a mustard seed. It should have the shape like a cow’s tail (slightly curved and graduated in dimension),^ with two rings (so that it can not be pushed farther than is necessary, or it might wound the bladder) and twelve digits long.” Charaha VIII. 9 . 28 - 291 **. It U VT 1 T 5 WIT ^ I Si^tT <m. It Hid* = 01 ^ ?tvr I <T PEii5l iv: XPai' W^RT shsra^'inil^t^, I V ^ tivr fiw’ HVdt I <i ?i<Rni[ it t ^ fVcTT, I 124. cTui I Vtw' a DISBASES 283 The underlying principles in the treatment of acute or chronic cystitis are (a) to render the urine bland and slightly antiseptic ; (b) to put the bladder at rest and to relieve pain ; (c) to lessen pelvic congestion. With healthy kidney and in non-suppurating cystitis of the bladder, the urine may be made bland by drinking a' good deal of whey or butter-milk or plenty of pure water. Hot baths, particularly hot sitz- baths are revulsive and counter-irritant. They relieve pain and congestion. To relieve conges¬ tion leeches may also be applied to the perito¬ neum and above the pubis. To make the urine slightly antiseptic, salol can be administered three times a day, in small doses of five grains. But in chronic cystitis, irrigation is the best curative means known. Irrigation removes mechanically decomposing discharges, diminishea the quantity of pus and mucus, renders the urine bland and unirritating, lessens the severity of the inflammation, lessens further fermentation and decomposition, and exerts a stimulating and healing influence upon the diseased membrane. The main symptoms of cystitis, fr-equency, urgency, tenesmus and strangury are chiefly dependent upon inflammation located 284 ANCIENT HINDU MEDICINE , about the vesical neck. Though irrigation, can not disinfect the entire diseased and suppurating tissues, this part can be easily reached, and the healing influence of a disin¬ fectant and soothing lotion can be easily exerted on it. This can be accomplished by irrigations, instillations or drainage, or all these combined. For irrigation, a n eak, non-irritating, antiseptic solution is preferable as silver nitrate 1; 5000 to 500, potassium permanganate 1 ; 5000 to 2000, carbolic acid 1: 500, boric acid 1 ; 50, normal saline solution 0. 7 per cent. Irrigation is only recommended when the patient urinates easily and empties his bladder completely. But bladder should not he distended to the point of causing pain and spasm. Usually one daily irrigation is sufficient, but in severe cases, it can be repeated. When urination is extremely painful, irrigation can be done by a soft catheter. The catheter is attached to a fountain syringe.