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.
Seattle.
Chairman, Bureau of Surgery