CHAPTER XVIII.

OF THE DIABETES, AND OTHER DISORDERS OF THE KIDNEYS AND BLADDER.

THE diabetes is a frequent and excessive discharge of urine. It is seldom to be met with among young people; but often attacks persons in the decline of life, especially those who follow the more violent employments, or have been hard drinkers in their youth.

CAUSES.—A diabetes is often the consequence of acute diseases, as fevers, fluxes, &c. where the patient has suffered by excessive evacuations: it may also be occasioned by great fatigue, or riding long journeys upon a hard trotting horse, carrying heavy burdens, running, &c. It may be brought on by hard drinking, or the use of strong stimulating diuretic medicines, as tincture of cantharides, spirits of turpentine, and such like. It is often the effect of drinking too great quantities of mineral waters. Many imagine that these will do them no service unless they be drank in great quantities, by which mistake it often happens that they occasion worse diseases than those they were intended to cure. In a word, this disease may either proceed from too great laxity of the organs which secrete the urine, from something that stimulates the kidneys too much, or from a thin dissolved state of the blood, which makes too great a quantity of it run off by the urinary passages.

SYMPTOMS. —In a diabetes, the urine generally exceeds in quantity all the liquid food which the patient takes. It is thin and pale, of a sweetish taste, and an agreeable smell. The patient has a continual thirst, with some degree of fever; his mouth is dry, and he spits frequently a frothy spittle. The strength fails, the appetite decays, and the flesh wastes away, till the patient is reduced to skin and bone. There is a heat of the bowels; and frequently the loins, testicles, and feet, are swelled.

This disease may generally be cured at the beginning; but after it has continued long, the cure becomes very difficult. In drunkards, and very old people, a perfect cure is not to be expected.

REGIMEN. —Every thing that stimulates the urinary passages, or tends to relax the habit, must be avoided. For this reason the patient should live chiefly on solid food. His thirst may be quenched with acids; as sorrel, juice of lemon, or vinegar. The mucilaginous vegetables, as rice, sago, and salop, with milk, are the most proper food. Of animal substances, shell-fish are to be preferred; oysters, crabs, &c.

The drink may be lime-water, in which a due proportion of oak-bark has been macerated.

The patient ought daily to take exercise, but it should be so gentle as not to fatigue him. He should lie upon a hard bed or mattress. Nothing hurts the kidneys more than lying too soft. A warm dry air, the use of the flesh brush, and every thing that promotes perspiration is of service. For this reason the patient ought to wear flannel next his skin. A large strengthening-plaster may be applied to the back; or, what will answer better, a great part of the body may be wrapped in plaster.

MEDICINE.—Gentle purges, if the patient be not too much weakened by the disease, have a good effect. They may consist of rhubarb, with cardamum-seeds, or any other spiceries infused in wine, and may be taken in such quantities as to keep the body gently open.

The patient must next have recourse to astringents and corroborants. Half a drachm of powder made of equal parts of alum and the inspissated juice, commonly called terra japonica, may be taken four times a-day, or oftener, if the stomach will bear it. The alum must first be melted in a crucible; afterwards they may both be pounded together. Along with every dose of this powder the patient may take a tea-cupful of the tincture of roses.

If the patient’s stomach cannot bear the alum in substance, whey may be made of it, and taken in the dose of a tea-cupful three or four times a-day. The alum-whey is prepared by boiling two English quarts of milk over a slow fire, with three drachms of alum, till the curd separates.

Opiates are of service in this disease, even though the patient rests well. They take off spasm and irritation, and at the same time lessen the force of the circulation. Ten or twelve drops of liquid laudanum may be taken in a cup of the patient’s drink three or four times a-day.

The best corroborants which we know, are the Peruvian bark and wine. A drachm of bark may be taken in a glass of red port, or claret, three times a-day. The medicine will be both more efficacious and less disagreeable, if fifteen or twenty drops of the acid elixir of vitriol be added to each dose. Such as cannot take the bark in substance, may use the decoction mixed with an equal quantity of red wine, and sharpened as above.