English
The lotion is allou^ed to flow through, and while it is flowing, the catheter is slowly passed into the bladder. Three to five ounces are injected and the tube leading to the fountain syringe is discontinued, and the injection is allowed to flow out. Instillations are applied by means of an DISEASES 285 instillator, which is a silver or hard rubber cylindrical catheter about 13 Fr. caliber,, provided with a fine canal. To the end of the shaft of the catheter is fitted a hypodermic syringe with a capacity for forty minims and is filled with a choice lotion, silver nitrate 1 to 5 per cent in gonorrheal cystitis, iodoform! emulsion in tubercular cases with ten per eent glycerine. The catheter is lubricated with glycerin or boroglyceride, and is introduced intO' the urethra until its tip is within the grasp of the compressor urethrae muscle. The piston of the syringe is then driven down, causing the injection to flow along the membraneous and prostatic urethra into the bladder. The simplest and the safest form of drainage is that by continuous catheterization. A soft catheter of medium caliber should be selected. Important points to observe are that the eye of the catheter lies just within the bladder and that the instrument thoroughly and continually drains this viscus. To determine the eye of the catheter in relation to the neck of the bladder, the instrument is introduced and the bladder is emptied. Pour to six ounces of boric acid solution are then injected, and the catheter is withdrawn until the fluid ceases to flow. It 386 ancient HINDU MEDICINE is then passed in until the fluid begins to flow, and is held in tliis position until the bladder is empty. This continuous catheterization may be kept up from one to three weeks. It usu¬ ally causes a mild traumatic urethritis. This is treated by withdrawing the catheter slightly at each irrigation until its end lies without the compressor urathrje muscle. By forcing an anti¬ septic solution into the catheter, it will then flash out the entire anterior urethra. In case of intense pain, suprapubic drainage can be also performed with advantage. The method adopted by the Charaka School is as follows :— “The patient after his bath, shall take meat broth or milk. And he shall be seated on a soft, easy and comfortable cushion, after he has evacuated his bladder when there is natural call. Then his penis should be massaged with oint¬ ment. After that a sound ( salaJca) should be introduced for the urethral exploration. If the sound passes without any obstruction, then it should be withdrawn, and the eye of the bougie introduced. All the regulations recom¬ mended for anal irrigation {enema) are to be observed. If the lotion is allowed to flow at great speed, it causes inflammation of the base. DISEASES 287 and if it be not sufficient, it does not spread all over the surface, so with a steady hand (not trembling), the bougie is to be introduced and withdrawn.” Charaka VII. 9.3“*. Prodrome of litkiasis : “Bladder-irritability, anorexia, strangury, lacerating pain at the neck of the bladder, scrotum and the urethra, fever, lassitude, and the goat-smell of the urine are the prodromes of lithiasis. Moreover, before the calculus formation, the color of the urine be¬ comes unnatural and micturition is painful. The urine is concentrated and cloudy (with urates ). The urine becomes corrupt with *vmju' ( ammoniacal decomposition ). Symptoms ;—With the calculi formation, there are pains in the umbiculus,bladder,scrotum. J.25. Kfjt qrorfs ^ I JRrefcTfcn 11 <Tct; Jltaitn I 288 . ANCIEiST HINDU MEDICINE urethra aucl their adjacent regions at the time of micturition, sudden interference with the flow of the urinal stream (by the spasmodic closing of the veluntary muscles when a small stone is forced into the vesical orifice), bloody urine (the blood is invariably present in the- vesical calculus, though the hemorrhage from the bladder is never profuse ; the quantity of blood and the degree of pain depends on the nature of ulcerated surface and the contour of the stone ), splashing urine, the color of the urine like that of a gem (reddish), clear urine containing sand ( uric acid crystals) and pain is much increased by running, jumping, riding and long journeys (violent movements are apt to cause friction of the stone with the vesical surface ),” Siisi'uta II. 3. 4-6’'“ 126 . ^fir wm: h a. f%cTT> ^ I DISEASES 289 ‘‘As gallstone is formed in a cow by desicca¬ tion of the bile, so calculus is formed. Calculi are formed in various shapes like that of the flower of 'nuclea cadamha' ( the oxalate-of-lime calculus is the hardest, often orange-dark in color, more or less spherical in form and studded with nodules, whence it derives its name as mulberry calculus ); like stone ( finely laminated stones are often found among th^e vesical calculi, with alternate layers of distinctly crystal¬ line oxalates and urates ; the urates are yellow- reddish in color ) ; smooth ( pure uric-acid stones are the softest, are yellow, red or brown in ■color and generally present a smooth surface); like pea {custin) or soft (amorphous phosphates). If the calculus is pushed against the vesical orifice, then the passage of urine is obstructed, und it provokes great pain ( the stone is grasped and forced against the sensitive neck either by the flow of urine or in violent motion as jolt¬ ing over a rough road or riding ). This exas¬ perates the patient and he makes i*epeated attempts to urination. There is defecation with tremor. There is lancinating pain in the scro¬ tum, urethra and the bladder, and if the urethra is wounded, the urine comes mixed with blood. But when the calculus is dislodged from the 19 290 ANCIENT HINDU MEDICINE vesical neck, the urine again flows with ease. If the calculus is split into fragments, it passes through the urethra and is called *sarhara* (gravel).” Charaka VI. 26. ^'Gravel {sarkariS), sand (sikata —uric acid brick dust, a fine yellow reddish sediment) and amor- phous phosphates (phasmakhya-mehd) are varieties of lithiasis. The symptoms and pain of gravel resemble that of calculus. If the calculi (con¬ cretions) are tiny, they are excreted with the urine, with favorable %ayu\ If the calculus is split up into minute fragments by *vayu\ it is called the gravel. The gravel causes heartache, fatigue of the thighs, pain in the perineum, tremor, polydipsia, nausea, cyanosis, anemia, weakness, anorexia and indigestion, if the gravel he obstructed in the passage through the urethra. 127. g ^rt: ii ’a arwgq ft w cw airlft g >1 f: sifps ^ ttft i ftsiWauv arfift it vturg cren; gw g^ft smraig i gfagRwfgfti". ■a<=ha'ftctT, t DISEASES 291 ^'The bladder is situated in the midst of umbi¬ licus, back-bone, pubic bones, scrotum, rectum, groin and the urethra. The bladder has only one orifice or outlet (urethra) and its base is down¬ ward, its skin (muscular coating) is thin. The bladder is like bottle-gourd (aldhu-lagenaria vulgaris ser) in shape and is covered with nerves, arteries and veins. The bladder is situated in the pelvis, between the pubic bones in front and the rectum (in woman, the uterus) behind. During the fetal and infantile life, it is usually situated above the pubes. It is a flattened, more or less horizontal body, when empty, but when distended, it becomes an oval bag and rises so aa to occupy more or less the hypogastrium. It is attached below, but free to expand above. It is essentially a muscular organ, lined with mucous - membrane and covered except in its lower portion with a loosely attached peritoneal coat. Into its lower and posterior portion, the ureters empty, and from its neck the urethra arises. When not over-distended, it holds about a pint of urine—somewhat more in woman than in man. It is a hollow organ, serving as a receptacle for the urine and has a strong muscular investment of unstriped muscles in several layers, which are innervated by. branches from the sacral nerves). 292 ancient HINDU MEDICINE The bladder, the bladder-neck, (perhaps including the prostates) urethra, testicles and rectum are aU united in one system (genito-urinary) and is situated within the pelvis. The other name of the bladder is the ‘receptacle for the excretory product' {malddhara), and it is a vital organ. As rivers discharge their waters into the ocean, so the tubules in the digestive canal {the hidneys are bean-shaped organs, about, 4!|- inches in length and 2 inches in width and li inches in thickness, lying on either side of the spinal column, behind the peritoneum, about opposite the twelfth thoracic and first three lumbar vertebrae. At the inner edge of each kidney is a concave depression, the ‘hylus', where the vessels and the nerves enter and leave the organs and where the ureter emerges. The kidney is enclosed in a fibrous envelope, the ‘capsule'^ which dips into the sinus at the hylus. The substance of the organ is divided into cortex and medulla. The former is darker colored and more granular in appearance than the latter ; it contains the Malphigian corpuscles and most of the convoluted tubules. The medulla is lighter in color and striated and contains the majority of the straight tubules ; it is formed of the pyramids whose bases rest in the cortex and DISEASES 293 whose aspices are the renal papillae at which point the central collecting tubule opens into a calyx, this in turn emptying into the pelvis of the kidney from which the water with the waste products of metabolism dissolved into it passes into the ureter and thence into the urinary bladder, discharges the urine into the bladder.