SUPPRESSION OF URINE.
Anuria, when the result of degenerative changes in the kidney, is usually beyond the reach of art, but the form which sometimes occurs in acute Bright's disease may be combated successfully by the use of the agents detailed in the article on that disease.
Anuria coming on soon after exposure of the overheated body to intense cold is (Inc to acute congestion of the kidneys, and its treatment is identical with that of acute Bright's disease, and the same remark applies to the suppression which sometimes follows poisoning by can tharides„ chlorates and digitalis. Calculous anuria is discussed under Stone in the kidney. The form of suppression which sometimes follows surgical operations on any portion of the genitourinary tract, as after the dilatation of narrow strictures of the urethra, and in catheterisation of a greatly distended bladder in prostatic disease when the surgeon draws off all the residual urine, requires prompt treatment in order to save life.
In such cases the best routine procedure is that which follows upon the lines suitable for the prevention and treatment of unernia. This may be advantageously carried out in all cases of urinary suppression when the diagnosis is uncertain. The renal organs having " struck work," any attempt to directly stimulate them will only increase the active congestion which is likely- to be present, and the chances of saving life will be seriously diminished. hence the administration of irritating or stimulating diuretics should he avoided in all cases.
The physician should endeavour to act powerfully upon the skin and bowels to effect vicarious elimination of the retained toxins. This should be accomplished by the hot pack, hot mustard, hot water, hot air, or vapour bath. Pilocarpine hypodermically is the most potent of all diaphoretics, but if its action is concentrated upon the kidneys or on the bronchial surface death may follow the administration of gr. If, how ever, the injection he not administered till the action of the skin has been stimulated by' external warmth, then all the force of the drug will be directed to time sweat glands, and further diaphoresis will be safely accom plished. Whilst the patient is thus sweating profusely in the hot pack a large dose (h oz.) Sulphate of Magnesium may he administered, and
repeated in half this amount to keep up a continuous drain from the bowel.
Cupping of the loins and hot poultices applied over these regions will act beneficially, not, however, by stimulating the kidneys, but by relieving their congestion. Decapsulation of the kidney has been recommended in desperate cases of eclampsia. Nitrites \yin also prove useful, as i-dr. doses of Spt. Ether. Nit.
A second indication is always present in this condition—i.e., to dilute the amount of the toxic substances ihi the blood and thereby to minimise the intensity of their action on the heart and on the nerve centres. To accomplish this object Normal Saline solution should be injected hypo dermically, by the bowel or by the veins. As the amount introduced by the skin has its limits, and as the bowel is being acted upon by the Mag. Su1ph., the venous route should he selected. The action of the saline as a diluent is enormously increased if blood-letting is first performed; 20 OZ. of blood may tlierelore he permitted to flow from the median basilic before very slowly injecting double this amount of serum or more.
By diluting, the poisoned blood flowing through the kidneys the saline solution often acts as a powerful but harmless diuretic, and sometimes the urinary secretion is almost immediately re-established. ‘N'here rigors and severe septic symptoms with high fever heat are present, as in post operative cases, it is obvious that the hot bath or pack has its limitations, and in such cases till the temperature falls the surgeon must rely upon saline purgatives, hot fomentations to the loins, and the intravenous injection of saline solution. Bloodletting will here again minimise the effect of toxins produced by the microbes which have gained admission by the employment of unsterilised catheters or other instruments intro duced into the urethra or bladder. Cardiac depression should be met by Strychnine hypodermically, or by _Alcohol by the mouth when urgently required, but Digitalis is to be avoided.
SWEATING—see Perspiration, Excessive. SYCOSIS— seeunder Tinea.