STONE IN THE KIDNEY.
Treatment will depend upon the symptoms present and upon the nature of the concretion and its exact site.
Gravel or the passage of renal sand, which is usually composed of a small conglomeration of the crystals of uric acid ur unites, is of tun unattended with pain or distress. The treatment of this condition is purely medical, and should consist in the correction.of the error in metabolism, which leads to the uric acid formation. Diet is of importance; red meat and food rich in nucleins and purin bases should be prohibited, and excesses in eating foods of all kinds should he warned against. Exercise in the open air must be assiduously carried out, and alcohol in every form forbidden.
Medicinal treatment will consist in the administration of diuretics to increase the amount of urine and diminish its concentration. Alkalies like Pot. Bicarb. given with Lemon Juice in effervescence and combined with Salicylates are valuable. A natural alkaline mineral water is the best routine, and Con trexeyille has long sustained its reputation as a resort for patients suffering from gravel. The free flushing out of the renal tract with this mineral water, which is rich in lime salts, often affords marked relief to those patients who continue to pass small uric acid calculi and renal sand.
When the small concretions consist of phosphates, the above treatment will only intensify the symptoms by rendering the urine less acid. The factor of mental strain which is present in most of these cases will demand serious attention. Change of air and scene with mental rest and physical exercise and regulation of the dietary--a liberal supply of animal food being necessary—are all clearly indicated.
Of drugs, none are so valuable as the Acid Phosphate of Sodium, which should be given to the amount of r oz. daily dissolved in 3 pints of water. By this means the urine may be kept acid for long periods, and concretions of phosphates and even small calculi of calcium oxalate may be dissolved. Mineral Acids, especially the Nitro-hydrochloric with Strychnine, are also always valuable. See the article on Phosphaturia.
Renal Colic is the name applied to the painful spasmodic seizure which accompanies the passage of small stones along the ureter. The best routine treatment consists in the administration of a very hot bath as soon as the first symptoms of the attack show themselves. The patient should
be kept in the bath under the surveillance of a discreet attendant till full antispasmodic action is produced, hot water being from time to time added to keep the temperature of the bath up to io4.' or io5°. The effect may be heightened by the administration of a large hot-water enema when in the bath or whilst this is being got ready.
As soon as a feeling of faintness is produced the spasm of the ureter often relaxes and permits the stone to pass down into the bladder. When the pain continues violent a full dose of Whiskey made into punch should be swallowed, and this can be follow ed by a hypodermic of fto gr. Morphia combined with r min. B.P. Solution of Atropine: the latter assists markedly the action of the narcotic. When the agony is unbearable Chloroform may be administered, and under the anesthesia some surgeons have satisfied themselves that pressure manipulation over the ureter has facilitated the passage of calculi which had become fixed. In the absence of the hot bath, a hot pack, hot fomentations, stupes and dry cupping over the loin may be resorted to.
The treatment of a stone which has become firmly impacted in the ureter will depend upon its exact location, which should be determined by X-ray photography, an opaque ureteral bougie having been placed in the ureter before the photograph is taken. Calculi which have become fixed at the entrance of the ureter into the bladder may be felt by the finger placed in the rectum, and by suitably applied pressure sometimes they may be driven into the bladder. This manceuvre failing, suprapubic eystotomy should be resorted to rather than au attempt at removal through the perineum ur vagina. For impacted calculi higher up, but within the pelvic zone of the ureter an extra-peritoileal operation should be performed through an incision which will permit the reflection of the peritoneum from off the iliac lossa till the ureter is reached behind the membrane. Calculi in this situation have also been removed by opening the ureter through an incision giving free access to the peritoneum as in other abdominal operations. The tube having been located, the posterior layer of the peritoneum will also require division so as to reach the ureter lying behind it.