CALCULI-A NEW CHEMISTRY AND THE INDICATED REMEDY


CALCULI-A NEW CHEMISTRY AND THE INDICATED REMEDY.
Read before I.H.A., Bureau of Surgery,. june 17, 1938.

C.P.BRYANT, M.D.

 …


Read before I.H.A., Bureau of Surgery,. june 17, 1938.

C.P.BRYANT, M.D.

 

It has been my custom for the past twenty-five years to advise my patients suffering from calculi that there was no hope of recovery other than surgery.

These conclusions I now consider with great reservation, due to what might be considered an accidental prescription based upon the symptoms of the patient himself in contra-distinction to the calculus produced symptoms. Little a did I realize at the time of prescribing Phosphorus for this patient that I would cause the rapid disappearance of a calculus in the pelvis of the kidney the size of a Mexican kidney bean.

This patient had been operated for a like sized stone in the opposite kidney and was convalescing from a nephrotomy done for the removal of a stone on the opposite kidney. He expected at some future date to return to the hospital for a second nephrotomy.

We have all experienced such startling results at various times in our lives when we were concerned more with the prescription based on the nervous or mental symptoms of a patient where we were not expecting gross pathological changes to disappear.

This concrete experience I have just described brought me to a sudden realization that even gross pathology and calculi of various parts of the body may disappear when the actual similimum has been discovered.

In Rehfus & Nelsons new book, entitled Medical Treatment of Gall Bladder Disease, published in 1936 by Saunders & Company, I quote from page 350 as follows:

“Today we realize that there is known treatment which actually dissolves gallstones in the human subject.”.

Again, in Practice of Medicine by Tice, vol. vi, page 720, 2e find:.

Medical treatment of renal calculi has only mythical value. If the patient has passed a stone, the drinking of large quantities of distilled water careful regulation of the diet and bowels, attention to the future stone, but stones once formed will never be influenced by power again or any other drugs, and the consideration of treatment is what along surgical lines alone.

Quoting again from page 719:.

Efforts to dislodge the renal stone by injection through the ureter catheter of cocainized olive oil is a procedure worthy of trial. Even if the patient develops occasional attacks of colic one can still pursue the policy of watchful waiting as the author has seen stones pursue the policy of watchful waiting as the author has seen stones giving the bladder. There are many problems and different situations which it may be necessary to consider in a patient who is subject to bilateral renal calculi.

If both kidneys are extensively diseased and the patient has not much pain and suffering, it may be the better part of wisdom not to good condition and the other kidney functionless, or nearly so, operation on the healthier kidney should be carried out. Nothing will be gained by working upon a useless organ, but conservation of a healthy kidney is essential.

In a recent issue of the International Medical Digest the statement is made that Raphanus niger in material doses has dissolved large hepatic calculi with permanent cures following.

Diet plays a most important role in all calculi whether they be renal, calculi an understanding of acid ash,alkaline ash and neutral ash diets is necessary. The addition to the diet of Vitamin A alone is valuable in the prevention of the formation of calculi. Blood chemistry studies are also of utmost importance. Determination of blood urea, creatinin, sugar, uric acids calcium, phosphorus and phosphates should be made in each case. These studies are of importance in cases in which calculi of the uric type are present, and also in those in which changes on the blood calcium and blood phosphorus may indicate the presence of parathyroid disturbances.

CHEMISTRY.

Theoretically,it seems possible that when the so-called protective urinary colloids are no longer able, for one reason or another, to maintain the urinary crystalloid material in a solution, precipitation of certain urinary salts occurs,and stones are formed.

It may be that this explanation is entirely false, however, as the electrolytic imbalance which results in the precipitation of the calculi may be entirely independent of any colloid action.

Clinically, obstruction and infection frequently are found associated with stones. We now that certain bacteria, such as Proteus ammoniae,staphylococci and certain streptococci which split urea into ammonia and carbon dioxide, thereby creating an alkaline urine, are the organisms most commonly associated with the presence of stones. The proteus ammoniae are particularly associated with recurrence of calculi. This emphasizes the importance of the pH. concentration in the urine. In these cases it appears that the urinary colloids are less able to maintain the crystalloids in solution when the urine is decidedly alkaline.

In discussing calculi in general it is to be kept in mind that there are various places in the body where calculi are common,namely:.

Calculi: Arthritic-gouty deposit of urates in or near the joint.

Biliary-chiefly of cholesterin.

Blood-(Phleboliths).

Dental.

Dental.

Intestinal-(Enterolith).

Pancreatic-urinary bladder, composed chiefly of calcium oxalate; consisting of calcium carbonate and phosphate with organic matter.

Prostatic-Usually phosphatic.

Renal-Composed usually of uric acid, calcium oxalate or phosphates.

Tonsillar-a calcareous concretion.

In a article entitled Bone Phosphatase, by my son, J.Trevor Bryant,University of Oregon Medical School, a number of authorities are quoted describing the theories of calcification in bone. I quote:.

Probably the widest accepted viewpoint put forward is that of Robert Robinson with his work on Enzyme Phosphatase. The Enzyme phosphatase has been shown in vitro to be capable of synthetic as well as hydrolytic activity. It maybe that the enzyme plays an active part also in bone resorption and demineralization under both normal and pathological conditions by synthesizing from some of the insoluble calcium phosphate of the bone,soluble phosphoric esters of calcium.

Viewing this brief discussion of the chemistry of calculi, it suggests the futility of surgery or the local treatment of any calculous deposit.

VITAMINS.

The vitamins most concerned in calculi are: Vitamins A, C and D.

Vitamin A.A fat soluble vitamin: promotes growth and increases the bodys ability to resist infections. Its deficiency promotes urinary calculi.

Vitamin C.A water soluble vitamin required for proper calcium metabolism. Its absence causes decalcification of bones.

Vitamin D. In the case of calcium, the amount required by the body depends upon the Vitamin D content of the food, calcium-=phosphorus ration,and the reaction of the bowel. Regulates the absorption and metabolism of calcium and phosphorus.

TREATMENT.

The routine necessary for permanent relief of calculi of the body must of necessity depend upon the proper regulation of the body chemistry, through:.

First: The proper diet regulation.

Second: A knowledge of body chemistry; and.

Third: The selection of the indicated remedy.

While diet can play a very important role in the cure of calculi by its effect upon body chemistry, the selection of the similimum will enable the body cells, through their metabolic processes, to select the proper proportion of vitamins required and thus produce the chemical balance.

DIETETIC MANAGEMENT.

As a general rule in the absence of infection the high Vitamin A acid ash diet is sufficient to render the reaction of the urine strongly acid,m but with patients in whom an infection such as the proteus organism is present, an acidifying agent may be necessary to add to the prescribed diet. Some authorities suggest sodium acid phosphate in capsules or ammonium chloride in enteric coated tablets.

It is important that the pH. of the urine be kept between 4.9 and 5.4, and the medication necessary to maintain similar conditions. the first morning specimen of the urine is discarded and a specimen voided just before breakfast is sent to the laboratory for examination. By this routine the effect of awakening respiratory changes on a pH. of the urine are eliminated and the effect of the alkaline tide is avoided.

ALKALINE ASH DIET.

Calculi due to oxalates. Diet for a combined Oxaluria and Uric-Acid Diathesis.

Omit:

Asparagus Cranberries Plums

Black Tea Endive Rhubarb

Chocolate Figs Sorrel

Cocoa Pepper spinach

Alcohol Liver Shad roe

Coffee Meat gravies Shellfish

Kidney Meat Soups Thymus

Lentils Mushrooms Tongue.

Sample Menu No.1 Breakfast:

Choice of orange,grapefruit, melon or grapes.

Shredded wheat with cream and sugar.

Crisp broiled bacon.

Melba toast.

Cereal, coffee with cream and sugar.

Luncheon:

Cream of pea soup.

Chicken salad.

Hot rolls with butter.

Baked custard.

Cereal, coffee with cream and sugar.

Dinner:

Mixed fruit cocktail.

Roast lamb, mint jelly.

Green peas with butter.

Browned sweet potatoes.

Braised celery.

Lettuce hearts, French dressing.

Rolls and butter.

Vanilla ice-cream.

Glass of milk.

Sample Menu No.2

Breakfast:

Sliced banana with cream and sugar.

Farina with cream and sugar.

Scrambled eggs.

Buttered toast.

Cereal coffee or glass of milk.

Luncheon.

Cream of corn soup.

Cheese omelet.

Toasted crackers.

Sliced pineapple.

Lemon wafers.

Cereal coffee with cream and sugar.

Dinner:

Cream of tomato soup with saltiness.

Toast chicken.

Mashed potatoes.

Buttered carrots.

Corn muffins and butter.

Apricot and cream cheese salad. French dressing.

Vanilla blanc mange.

Glass of milk.

Sample Menu No.3

Breakfast:

Sliced peaches or pears (fresh or canned).

Oatmeal with cream and sugar.

Poached eggs on toast.

Marmalade or honey.

Buttered toast.

Cereal coffee or milk.

Luncheon:

Cream of celery soup.

Cold sliced chicken or lamb.

Baked macaroni with cheese.

Whole-wheat muffins with butter.

Apricot whip or rice and raisin pudding.

Cereal coffee with cream and sugar.

Dinner:

Cream of potato soup.

Broiled lamb chop.

Baked potato.

Creamed cabbage.

Buttered beets.

Pineapple and cream cheese salad.

Graham rolls and butter.

Orange-ice or fresh fruit compote.

Glass of milk.

ALKALINE ASH DIET.

For calculi due to urates (urine always acid)

Fruits: Bananas Oranges

Apples Blueberries Peaches

Apricots Grapes Pears

Pineapple Grits Vegetables:

Plumbs Oatmeal All except

Tomatoes Rice Asparagus

Dairy Products: Sago cabbage.

Tapioca Cauliflower

Hens eggs Rolls Eggplant

Cream White Bread Green peas

Milk Nuts: Lima beans

Butter.

Almonds Mushrooms

Cereals: Hazelnuts Spinach

Barely Walnuts Split peas.

These foods should be liberally utilized.

ACUTE STATE.

Sample Menu No.1

Breakfast:

Class of orange juice (chilled).

Oatmeal gruel with milk and sugar.

I soft-boiled egg.

Milk toast.

10:00 a.m.Glass of pineapple juice.

Luncheon:

Barley gruel.

Boiled rice with butter.

Carrots, pureed.

Sliced tomatoes.

Rolls and butter.

Sliced peaches with cream and sugar.

Glass of orangeade.

3.00 p.m.Glass of milk and vanilla blanc-mange.

Dinner:

Poached egg on toast.

Apple tapioca pudding.

Glass of grape juice.

9.00 p.m. Fresh fruit such as apple, orange or plum.

Sample Menu No.2

Breakfast:

Sliced bananas with milk and sugar.

Egg scrambled in milk.

Toast

Milk.

10:00 a.m. Glass of tomato juice (chilled).

Luncheon:

Baked potato with butter.

String beans,buttered.

Lettuce with French dressing.

White bread and butter.

Baked custard with fruit juice.

Glass of milk.

3:00 p.m. Glass of grape juice (chilled)

Dinner:

Oatmeal gruel with cream and sugar.

Vegetable plate with poached egg.

Blueberries.

White bread and butter.

9:00 p.m. Glass of pineapple juice (chilled).

Sample Menu No.3

Breakfast:

Glass of grape juice (chilled).

Oatmeal gruel.

1 soft-boiled egg.

Toast and butter.

Glass of milk.

10:00 a.m. Glass of organic juice.

Luncheon:

Tomato soup with rice.

String beans, pureed.

Creamed potatoes.

White bread and butter.

Floating island.

Glass of pear juice.

3:00 p.m. Glass of milk.

Dinner:

Glass of plum juice (chilled).

Barley gruel.

Poached egg on toast.

Baked custard with blueberries, other fruit.

Glass of milk.

9:00 p.m. glass of pineapple and orange juice.

Omit these foods in following diets:

Omit:

Alcohol Farina Peas, green

Anchovies Fish, all kinds Pork

Asparagus Goose Rabbit

Beans,dried Graham flour Rhubarb.

Beans, dried Graham flour Rhubarb

Beans, lima Hominy Sardines.

Beef Kidneys Shellfish.

Broths Lentils Soups, stock

Cauliflower lIVER sPINACH

Cheese Meat gravies Sweetbreads.

Coca Mushrooms Tea.

Coffee Mutton Tongue

Duck and all game Peas,dried Veal.

Sample Menu No.1

Breakfast:

Baked apple with cream.

Wheat with cream and sugar.

Poached egg on the toast.

Muffins (not Graham) with butter.

Glass of milk.

Luncheon:

Stuffed tomato.

Baked squash.

Beet and egg salad,French dressing.

Bread and butter.

Pineapple snow.

Glass of milk.

Dinner:

Baked potato with butter.

Buttered beets.

Sliced tomatoes and lettuce, French dressing.

Bread and butter.

Apple tapioca pudding.

Glass of milk.

Sample Menu No.2

Breakfast:

Stewed peaches with cream and sugar.

Cream of wheat with cream and sugar.

Boiled eggs.

Toast and butter.

Glass of milk.

Luncheon:

Macaroni and stewed tomatoes.

Lettuce salad, French dressing.

Bread and butter.

Orange sherbet.

Glass of milk.

Dinner:

Creamed potatoes.

Buttered carrots.

Vegetable salad, oil dressing.

Bread and butter.

Baked rice custard.

Glass of milk.

Sample Menu No.3

Breakfast:

Sliced oranges or orange juice (chilled).

Oatmeal with cream and sugar.

Scrambled eggs.

Rolls with butter.

Glass of milk.

Luncheon:

Creamed eggs on toast.

Creamed celery.

Alligator pear salad.

Bread and butter.

cup custard.

Glass of milk.

Dinner:

Scalloped potato.

String beans, buttered.

Bread and butter.

Fruit salad.

Fruit jelly cream and sugar or jello.

Glass of milk.

NATURAL ASH DIET;

Butter

Cream

Oil

Lard

Sugar

Cornstarch

Tapioca.

It is essential that the pH. of the body be determined before dietary regimen is instituted, and this should be checked at intervals while the patient is following his treatment. Each patient must be individualized and the constituents of the basic-i.e., the carbo hydrates, proteins, and fats-are varied until the desired pH. of the urine is attained. The patient is taught to make his own determination of the pH., The high Vitamin A ash diet is employed when calculi are composed of calcium, magnesium, phosphate, carbonates, uric acid, cystine or oxalates.

I quote from the International Medical Digest, June 1937, the British Journal or Urinology, 9: 36-46, March, 1937:.

In a collected series of 32 cases in which a calculus was too large to pass spontaneously, or was so located that its passage through the ureter and renal was impossible, spontaneous dissolution has occurred following dietary treatment in every case.

In one instance the calculus was composed of cystine and in three instances of uric acid. Obviously the alkaline-ash diet was used in this group.

In 28 cases calculi, composed of phosphates and carbonates which are formed in an alkaline urine, underwent dissolution. In this group the acid-dish diet was employed.

HOMOEOPATHIC REMEDIES.

By the foregoing discussion of this subject it comes evident that calculi are never a local disease, but a part of general body chemistry. Thus it becomes imperative to apple the remedy based upon the general characteristics of the patient and not upon local pathology. This explains the sometimes miraculous cures when a remedy selected for a given patient without knowledge of the calculus in his body has produced a apparent spontaneous cure of the calculus.

Chionanthus: has a marked effect upon blood calcium and Calcarea renalis and Lapis renalis reduce blood calcium, gravel and renal calculi.

These remedies are mentioned in Boerickes Materia Medica, 9th Edition.

I have made use of Calcarea renalis in those cases where no general symptoms of the patient were obtainable. In one patient now under treatment by this remedy alone a renal stone has been reduced to one-half its original size, radiographic pictures being taken every six months. Eventually it is expected that there will be complete disappearance of the calculi in this patient.

Phosphorus: in the pathogenesis of Phosphorus we find that Phosphorus destroys bone, disorganizes the blood. It is especially useful in tall, slender persons,narrow chested with thin, transparent skin; great nervous debility; very sensitive to external impressions, noise, odors, touch, electrical changes; great lowness of spirit; apprehension; loss of memory;craves cold, salty and sour;sour taste and sour eructations; water is thrown up as soon as gets warm in stomach; haematuria; turbid urine, brown with red sediment.

Mercurius cor.: Low spirit; urination frequent, painful with marked tenesmus; urine thick, acid, albuminous, containing granular, fatty bloody casts.

Arsenicum alb.: Restless; fretful, apprehensive, worse after midnight; headache with vertigo; oedema of lids; burning on urination; urine scanty, dark,yellow, turbid.

Lachesis;Vertigo, flickering before the eyes; vision dim with flicker before eyes; aggravation during and after sleeping; frequent urination urine copper colored or like coffee grounds,containing high percent of albumin;patient cannot ear anything right about body.

Cuprum ars: Vertigo,confusion,dark spots before eyes; frequent urging to urinate, burning lasting some time after urination; urine is dark red; great nausea; cramps in abdomen, fingers and toes.

Pareira brava:Sensation as if bladder distended; pains go down thighs; constant urging with great tenesmus; pains go down thighs during efforts to urinate; can emit urine only when he goes on his knees; incontinence after urination;violent pain in glands genus; itching along being buried alive.

Lycopodium: Most often indicated for urinate stones; worse right side of body or travels from right to left; intellectually keen but weak i muscular development; worse 4:00 to 8:00 p.m. Craves everything warm;acid eructations (water and gas); pain in the back before urinating; ceases after flow; slow in coming; must strain;. heavy urinate sediment. Polyuria,during night.

Argentum nit: Great desire for sweets;splinter-like pains; melancholic; hurried; time passes slowly; tremulous; eructations very loud; incontinence of urine;urethritis with pain, burning and itching, pain as from splinter; urine scanty and dark;emission of a few drops after having finished urination; bloody urine;worse from warm and cold foods; sweets; left side; better from eructations, fresh air, cold, and pressure.

Sarsaparilla: Despondent,sensitive,easily offended, ill humored and taciturn; urine scanty,sandy., containing mucus, bloody; severe pain at conclusion of urination; uric dribbles while sitting; child screams before and while passing urine; mostly right kidney calculi;tenesmus.

Berberis vulgaris; rapid change of symptoms; shifting pains; thirst alternates with thirstlessness;hunger alternates with loss of appetite; old gouty constitutions; pain in region of the kidneys is most marked. Useful in both gallstones and renal calculi; haematurial; burning on urination; sensation as if some urine remained after urinating,urine contains thick mucus and is bright red; mealy sediment; bubbling sore sensation in kidney regions; pain in thighs and loins on urinating and burning pains when not urinating.

Ocimum canum: pain from kidney into ureters with passage of red sand or red sand in urine. This remedy is one of greatest remedies for renal colic.

Polygonum; Coli and calculi (Polygonum persicaria).

Juncus eff.: Great solvent for renal or gallstones.

At this point I quote from S.Jermann, a Method of Dissolving Phosphate Concrements of the Urinary Passages, Munchen med. Webnschr, 82; 540,1935, as follows;.

Phosphatic concrements are for the most part dissolved by free gluconic acid in vitro after several,days, when slightly heated. Other Concrements, especially urate concrements, are not dissolved. Mixed Concrements,when the composition is favorable, and they contain phosphates and carbonates, may be loosened and their disintegration my be brought about…. Gluconic acid may be produced chemically as well in a microbiologic manner.

The sugar- containing syrup, Kombuchal Norgine,contains about 20 per cent free gluconic acid and may be employed instead of the chemically pure gluconic acid. A 2 or 3 per cent chemically pure gluconic acid or the corresponding quantity of Kombuchal maybe given distributed over a day, especially with meal;s up to one liter per day. More concentrated solutions of gluconic acid must be avoided.

Following the ingestion of a corresponding quantity of free gluconic acid or of Kombuchal, the alkaline urine becomes acid within a few hours. Turbidities and precipitations which manifest themselves in phosphaturia disappear, entirely, so that the urine becomes absolutely clear.

Again,I quote from Charles C.Higgins, Production and Solution of Urinary Calculi, Experimental and Clinical Studies, Journal of the American Medical Association, 104; 1926 (April 13) 1935, as follows:.

It was been the routine procedure at the Cleveland Clinic to administer to patients who have been operated on for urinary calculi a special acid ash diet high in vitamins, especially in vitamin A. Vitamin A is also added in the form of cod liver oil or halibut liver oil, a teaspoonful three times a day. The patient is instructed to test the urine morning and night with litmus paper, and on each visit to the clinic a urine analysis, including the pH. is made…In each of two n instances a small stone in the lower calix of the kidney too large to pass spontaneously has disappeared entirely within four months.

In two patients multiple large bilateral calculi have decreased definitely in size within thirteen months. Another patient had a large silent stone completely filling the left kidney; after the patient had taken the high vitamin diet for six months 323 small calculi were passed. The other two patients have been on the diet for only a short time. Several other physicians have used the acid ash diet and vitamin A in the treatment of their cases and the collected series in which calculi have disappeared now numbers eighteen.

The use of cod liver oil to supply the necessary Vitamin A is beneficial and wise since it not only supplies large quantities of Vitamin A but also supplies Vitamin D, whose function is concerned with the fixation of calcium and phosphorus in the body. Also carotene in oil is of like benefit.

It is well to bear in mind hyperparathyroidism. The presence or absence of this condition must be determined in all patients with calculi high in phosphates. This is accomplished by determining the calcium and inorganic phosphorus in the serum and the urinary calcium excretion. Stones present in this condition require correction of the hyperparathyroidism.

Many other remedies might be added. There is but one great essential necessary to cure calculi, namely,the careful recording of all symptoms followed by repertorial work and materia medica comparison. Remedies unknown as remedial agents in treatment of calculi may be found to bring about prompt cures.

Illustrating the foregoing paper I herewith present photographs of actual calculi passed from the urinary tract as a result of homoeopathic treatment. In none these patients has there ever been free from further evidence of stone formation over a period of our years. SEATTLE, WASH.

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