HYDROCELE WITH VARICOCELE.
WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:
[Illustration: D. Huntington, Esq.]
_Gentlemen_--About five years ago, having been a patient at, the Invalids' Hotel and Surgical Institute and undergone a painless operation for the cure of hydrocele and varicocele--which was performed to my entire satisfaction. I desire to express my thanks to the Medical Stuff for their skillful treatment of my case. Two weeks from the time of the operation I returned home, radically and permanently cured.
I recommend all similarly afflicted to consult the World's Dispensary Medical Association.
Yours truly, DANIEL HUNTINGTON, Huron, Beadle Co., So. Dak.
TWENTY-TWO YEARS' STANDING--UNSUCCESSFULLY TREATED BY OTHERS.
WORLD'S DISPENSARY MEDICAL ASSOCIATION, Buffalo, N.Y.:
[Illustration: E.L. Waters, Esq.]
_Gentlemen_--I wish to acknowledge that you have cured me of the worst case that ever came within my knowledge, it having afflicted me twenty-two years. After I had suffered much from other surgeons without any cure being effected, and with only relief for a short time, you performed a not only painless but very scientific operation, and with medicine completed the cure. It is now five years since you treated me and no symptoms of the disease have shown themselves. I will also add that while with you at the Invalids' Hotel I received the best of care and attention from the well trained nurses in your employ, for all of which I feel grateful.
With respect and best wishes, EDWIN L. WATERS, Athol Centre, Mass.
THE URINARY ORGANS:
THEIR ANATOMY, PHYSIOLOGY AND PATHOLOGY.
By reference to Fig. 1 the reader will get a good understanding of the relative positions of the kidneys, bladder, and adjacent organs.
THE KIDNEYS.
It is hardly necessary to discuss the minute structure of these organs in a book intended for the non-professional reader.
The function of the kidneys is to remove certain waste materials from the blood. As fast as excreted by the kidneys, the urine passes through the ureters, of which there are two,--one leading from each kidney, into the bladder. The ureters are lined with a continuation of the mucous membrane, reflected from the bladder upwards, and this lining also extends to the cavities of the kidneys.
Calculi or gravel, and stones, forming, as they sometimes do, in the kidneys, and passing down through these delicate and sensitive canals, cause excruciating pain. The symptoms of renal calculi passing from a kidney to the bladder are, as already indicated, severe cutting pain in the loins, and along the ureter, attended with considerable fever. A very rough stone, such, for instance, as a mulberry calculus, passes with considerable difficulty, and the patient is often suddenly seized with excruciating agony in the loins and in the groin, the pain also shooting down into the testicle of the corresponding side, often causing it to retract. There is usually, also, sympathetic pain shooting down the thigh. We have seen patients roll on the floor in the greatest agony, cold sweat meanwhile pouring down their faces, when thus suffering. The patient may also vomit violently, through nervous sympathy. The urine is apt to be bloody, and there is a constant desire to pass it. There is pain in the end of the penis, and also in the lower portion of the abdomen.
THE BLADDER.
This is a sac, or reservoir, to receive and hold the urine as it comes from the kidneys through the ureters. Its walls are partly composed of muscle, and partly of a lining mucous membrane. The muscular coating is external, and it is by its contraction that the urine is expelled. When empty, the bladder shrinks down to a small size, as compared with its distended condition. When filled, it is capable of holding about one pint. If it is distended by the retention of urine much beyond this capacity, the muscular coats lose their force, and often the urine cannot be passed naturally. In health, when the bladder becomes filled and distended, there is a consequent desire to empty it by passing water.
[Illustration: Fig. 1.]
The voiding of the urine should not be attended with the slightest pain or disagreeable sensations, and the desire to pass it should not be frequent. When there is frequent desire to pass it, or when its passage is attended with pain, there is irritation, or inflammation, in the coats of the bladder, or in the urethra. This may arise from an excessively acid or irritating condition of the urine, as well as from various other causes. Gonorrhea, or clap; stricture of the urethra, which impedes the free flow of the urine; enlargement or inflammation of the prostate gland; gravel, and stone in the bladder, are all capable of creating a frequent desire to pass water. Whatever the unhealthy condition may be which gives rise to this troublesome symptom, it calls for prompt and skillful treatment, for the most trivial affections of these organs often pass into those that are exceedingly intractable, if not incurable.
THE EXAMINATION OF THE URINE. The urine itself, when subjected to microscopical or chemical examination, as we shall hereafter more fully explain, offers the best means of determining the exact nature of these distressing affections. When normal, the urine is of a pale straw-color, and throws down no deposits on cooling. In passing it no difficulty or pain should be experienced, and it should spurt from the urethra in a full, round, and regular stream, until the bladder is entirely emptied.
If the stream is forked, checked, or interrupted in any way before the bladder is completely emptied, it is evidence that something is wrong.
Stricture of the urethra, prostatic disease, and gravel, or stone in the bladder, are all capable of producing obstruction to the free flow of the urine.
HOW SLIGHT AILMENTS BECOME DANGEROUS DISEASES. As we have before stated, the mucous membrane lining the bladder is reflected upwards into the ureters, lining these canals. By reason of this continuity of mucous surfaces, patients suffering from urethral, prostatic, and bladder affections, often die from disease of the kidneys. It must not be supposed that because stricture of the urethra does not co-exist with _Brights_ disease, that the latter may not have been caused by the obstruction in the urethra due to stricture. Pulmonary consumption, for instance, often begins in the form of nasal catarrh, but, by the continuity of the mucous membrane, it travels, so to speak, into the throat, or pharnyx; from the pharnyx into the larnyx, and then into the lung structure itself. The disease is transferred from the nose into the lung tissue. What occurs in the nasal, laryngeal, and pulmonary tract of mucous membrane, happens, also, in the urinary tract. A gonorrhea, which is a specific acute inflammation of the urethral canal, leaves behind it a slight gleet, or chronic inflammation of the mucous membrane of the urethra. This may give little inconvenience for a number of years, but gradually it culminates in a stricture, or, implicating the prostatic portion of the urethra, occasions inflammation of the prostate gland, and, perhaps, enlargement of this organ. This gradually gives rise to cystitis, or inflammation of the bladder. From the bladder, the disease travels up the ureters into the kidneys, and finally _Brights_ disease is established in these organs.
The mucous membrane lining the bladder also extends through the urethra.
Throughout the interior of the body, whether it be in the stomach, lungs, or other parts, this lining mucous membrane serves as a protection to the parts beneath, just as the skin on the exterior of the body serves as a protection to the sensitive true skin and the tissues underneath it.
THE CAUSE OF CERTAIN DISTRESSING SYMPTOMS. Close to the neck of the bladder is a triangular space, on which the mucous membrane is smoother, and devoid of folds, or rugae, and which is far more sensitive and vascular than other portions of the mucous membrane lining this organ.
It is called the _trigone vesical_. This _trigone_ is the most depending part of the bladder. If there be stone in the bladder, it naturally gravitates and rests on this sensitive space, so that, when the bladder is empty, the foreign body occasions inconvenience, until the urine, trickling down through the ureters, and intervening between the mucous membrane and the stone, serves as a temporary protection to the mucous surface. Hence the pain becomes less as the urine is secreted, until the water is again passed, and the intervening fluid thereby removed, when the stone again presses upon, and irritates, the sensitive _trigone_, by coming into more immediate contact with it. The greater ease with patients afflicted with stone experience in a recumbent position in bed, or on a sofa, compared with being in an erect posture, is easily explained. The foreign body, when the patient is standing, walking, or riding, falls by its own gravity on this sensitive spot; when in a recumbent position, it rolls away from this sensitive _trigone_ into the back part of the bladder, where the mucous membrane is less sensitive; consequently, the patient suffering from stone in the bladder is more easy at night, whereas, one suffering from prostatic disease, whether it be inflammation of the prostate gland, or enlargement of that organ, is usually worse in bed.
HOW BLADDER DISEASES COME TO BE CONFOUNDED WITH OTHER DISEASES. The bladder is largely supplied with blood-vessels, lymphatics, and nerves, given off from the same systems that supply the rectum or lower bowel, and in females the uterus or womb, and the ovaries. This accounts, in a great measure, for the symptoms of bladder disease in those afflicted with piles, or other diseases of the lower bowel, or of diseases of the uterus or womb in the female. We have frequently been consulted by patients who had erroneously supposed themselves to be suffering from disease of the bladder, or of the prostate gland, but whom we found, on examination, to be suffering from hemorrhoids, or piles. In these cases, by removal of the pile tumors, the frequent desire to urinate, and all pain in the region of the bladder, are promptly relieved. Sometimes, ulcers located in the rectum, give very little unpleasant sensation in the bowel, but produce pain in the bladder, with frequent desire to urinate. Enlargement of the uterus, the womb, or displacements of that organ, as prolapsus, or anteversion, and all capable of producing symptoms of bladder disease. A frequent desire to urinate and more or less sharp pain in the region of the bladder are usually experienced in these cases. Disease of the bladder, in like manner, often produces an apparent disease of other organs through sympathy, and without great care in diagnosticating each case, the _effect_ may be taken for the _cause_, and the patient treated for a disease which does not really exist.
THE URETHRA.
The urethra, in the male, is the canal extending from the bladder to the end of the penis, through which the urine is passed. This canal starts from the base of the bladder, passes through the prostate gland, and, entering the penis, continues of about uniform size along the under part of the penis until it reaches the glans, or head of that organ, where it expands somewhat into a bulb-like fossa, or cavity, and becomes reduced again at the orifice. At a short distance from the bladder it receives the outlets of the seminal ducts. The urethra is a most delicate and sensitive canal, and is surrounded by tissues of like delicacy, and is lined with a mucous membrane which is highly vascular, and filled with sensitive nerves. The introduction of any instrument into this canal is to be undertaken only when absolutely required, and when necessary. It should be so skillfully and carefully effected that no pain or irritation can result. The slightest awkwardness is liable to cause an unnoticeable injury, which may result in a false passage, or an effusion of plastic lymph around the canal, which, organizing, forms the most troublesome kind of organic structure. By proper and early treatment all danger and pain is avoided, and a cure effected in a very short time. In an extensive practice, in which we yearly treat thousands of cases, we have never yet failed to give perfect and permanent relief from stricture, or disease of the prostrate gland, without the necessity of using cutting instruments of any kind, when we have been consulted before injury to the urethra has been produced by the improper use of instruments. Having specialists who devote their entire time and attention to the study of these diseases, we are able to relieve and cure a large number painlessly and speedily, in which the awkward manipulations of physicians or surgeons, whose hands, untrained by constant and skillful use, not only fail to effect any benefit, but set up new, or aggravate existing, disease.
This subject will receive a more full and complete consideration in another part of this treatise.
THE PROSTATE GLAND.
The prostate is a gland of about the size and shape of a large chestnut, lying just in front of the bladder, and surrounding the urethra. The size of the prostate gland varies considerably with the age of the person. In early life it weighs but a few grains. As puberty approaches it becomes larger, and in the adult weighs from half an ounce to an ounce. In old age it enlarges considerably, and sometimes presses upon the bladder so as to impede the flow of urine. This condition is often confounded with stricture, gravel, or stone in the bladder, by inexperienced physicians. Hypertrophy, or enlargement of the prostate gland, is not an unfrequent disease in the adult or middle-aged man.
Being in close contact with the bladder, when it enlarges it encroaches on the bladder, pressing on it, and it has the effect of interfering with the function of urination. As before indicated, enlargement or hypertrophy of the prostate gland, is often confounded with stricture, gravel, and stone in the bladder, by inexperienced physicians, and treated accordingly. The true condition of this gland is readily determined by an examination through the rectum or lower bowel, the finger of the expert surgeon being able to determine at once whether it is enlarged or not.
THE DANGER OF BAD TREATMENT. In disease of the prostate gland, as well as in inflammation of the kidneys and bladder, stricture of the urethra, and many other forms of urinary disease, the use of stimulating diuretics, and the much-advertised "kidney cures," "buchus," and similar preparations, which largely increase the flow of urine, simply aggravate, and do positive harm. In fact, the most difficult cases that we have had to deal with have been those that, through such treatment, either taken on their own account or prescribed by inexperienced physicians, have been rendered so much worse as to make their cases very intractable, and tedious to relieve and cure.
REQUIRE NICELY ADAPTED TREATMENT. As we have heretofore indicated, there is no class of diseases that require nicer adaptation of medicines to each individual case, than those of the urinary organs. Medicines which, in one stage of these diseases are beneficial and curative, in another stage are often exceedingly injurious. Hence it is that we claim it to be impossible for any one to put up any set prescription, or proprietary medicine, that will meet the wants of a large percentage of this class of cases. The only rational course to be pursued is to examine carefully each case as it is presented; find out the exact condition and stage of the disease with which the patient is afflicted, and then prescribe for it such special medicines as are nicely and exactly adapted to the patient's condition. These, in many cases, will have to be changed from time to time, to suit the ever-changing condition of the disease, as it is modified by the treatment. Not only have the manufacturers of "buchus," "kidney cures," etc., committed grave errors by prescribing stimulating diuretics for almost all kidney and bladder diseases, under the impression that, as the patient passes only a small quantity of urine at a time, the kidneys should be stimulated to secrete more, but physicians in general practice have been very prone to commit the same error in their practices. When the bladder and kidneys are in a weak and diseased condition, incapable of efficient action, the bladder being already unable to dispose of the diminished quantity of urine secreted, it is simply outrageous practice to administer medicines calculated to stimulate the kidneys to perform more work. By being thus forced, these organs become seriously diseased. It would appear most unreasonable to whip and spur a horse already jaded from overwork. Common sense would dictate rest, which always does good; but, as the bladder is weak, the doctor whips up the kidneys with drugs, thus endeavoring to force them to secrete more urine, and thereby the poor, crippled bladder, which is incapable of disposing of even the diminished quantity secreted, is actually made to do more work in a diseased and feeble condition, than it would perform in a sound, strong, and healthy state. The results of this pernicious practice are _Bright's_ disease of the kidneys, cystitis or inflammation of the bladder, and numerous other grave maladies.
KIDNEY DISEASE.
Diseases of the kidneys are generally very slow in their inception, coming on gradually and manifesting no special symptoms of their presence until they have assumed a formidable character. For this reason they are the more dangerous. Simple derangement of the urinary secretion is no evidence of disease of these organs, as changes in the color, quantity and specific gravity of the urine are often produced by changes of temperature, active or sedentary habits, mental emotion, and sometimes by articles of diet, or drink, as well as by the use of different drugs.
The existence of disease of the kidneys in the early stages can only be positively determined by a microscopical and chemical examination of the urine, which reveals to us the presence of casts, epithelia, blood, pus, etc. The microscope informs us not only of the presence of disease, but very often of the particular portion of the kidney in which it is located, as well as of the stage which the disease has reached. We are also aided by chemistry in determining the exact abnormal condition of the kidneys by the detection of albumen, sugar, etc. These examinations, by aid of the microscope and chemical re-agents, should never be neglected by the physician. Without them his diagnosis, or judgment of the patient's condition, is simply guess-work. With them he is enabled to base his treatment upon certain and positive knowledge of the patient's real and true condition.
The usual symptoms of chronic disease of the kidneys, but which vary materially with the age, constitutional peculiarities and temperament, are weakness in the small of the back, pains in the region of the loins and groins, numbness of the thigh on the side of the affected kidney (for often only one organ is affected), high-colored and often scalding urine, many times depositing a sediment, sometimes white or milky urine, bloody urine, frequent desire to pass the urine, partial impotency, pains in the testicles and shooting into the loins, suppression or inability to pass the urine, gravel, stone in the bladder, dropsical swellings, swelling of the testicles, irritability and pain in the bladder, mucous and sometimes seminal discharges oozing from the urethra.
WHEN THE BLADDER IS AFFECTED the prominent symptoms usually complained of are irritability of the bladder, accompanied by a frequent desire to urinate, inability to retain more than a small quantity of urine, and this for a short time only, pain in the region of the bladder, extending into the back, thighs, etc., hot scalding sensations in passing the urine, sediment in the urine, and sometimes bloody urine. The appetite is usually diminished, there is a depression of spirits, the urine is often passed only by drops, and is irregular in quantity and quality, frequent inability to pass the urine at all, in males partial impotency, with dull disagreeable pain in the testicles and irritation of the urethra, attended with mucous and sometimes seminal discharges oozing from the urethra. Some of these symptoms may be present as the result of functional or organic disease of other organs than the kidneys or bladder, and to distinguish them with positive certainty is impossible without the aid of a microscopical and chemical examination of the urine.