POLYURIA AND OBSCURE CASES OF RETENTION. CASES AND TREATMENT
As already stated the diagnosis of an enlargement of the prostate is very easy, if the patients suffer from symptoms of the urinary organs. But there are prostatic patients suffering from a chronic uraemia due to a chronic retention of urine without any symptoms pointing to a prostatic obstruction of the urinary flow. On the contrary most of these patients suffer form a polyuria, the main symptoms pointing to the digestive organs. Nearly all these patients have been diagnosed and treated as cases of malignant diseases of the stomach, of the liver, of the bowels or of diabetes insipidus for many years without any success, till finally and experienced urologist is able to make the correct diagnosis. The following case may illustrate my statement:
G.M., 64 years of age, has been suffering for the last 11 years from progressive cachexia; loss of appetite, increased thirst, polyuria, constipation alternating with diarrhoea, flatulence, vomiting, pain in the stomach and in the region of the liver. He lost 18 kg. of his weight, and for the last four years he could not do any work at all, always suffering from serious headache, sleeplessness and heart troubles. He has been treated by a great number of allopaths and homoeopaths, each of them making another diagnosis. One diagnosed cancer of the stomach, another spoke of tubercular enteritis, others diagnosed chronic nephritis, pernicious anaemia, etc. The patient never complained about bladder troubles, none of his doctors did ever blame his urine in spite of his polyuria. Finally his physician, diagnosing chronic Bright’s disease, asked me to see his patient. The patient was in a terrible condition, emaciated, his skin dry, yellowish, the eyes sunken, the tongue extremely dry, reddened and coated, pulse very hard, irregular, blood pressure 206. May first impression was: chronic uraemia due to a chronic retention of urine. When I told the physician my idea, he and his patient were very doubtful of my diagnosis, saying there can be no retention of urine, there is no bladder trouble at all, on the contrary the patient passes too much urine. Indeed, when I gave the patient a large tumbler he passed about a pint of clear urine, specific gravity 1010, no albumen, no. sugar. Paying attention to the diminished strength of the urinary flow I told the physician that I have now no doubt regarding my diagnosis, but neither the doctor nor the patient could believe me. After the patient had undressed I called his doctor’s attention of the lower part of the patient’s abdomen. There was a distinct prominence above the pubes reaching nearly to the umbilicus. “Well,” I asked the doctor, “what do you think about that tumour?” “I’m sorry,” answered the doctor, “I never examined the abdomen, I do not know what that means.” I will tell you,” I replied. “That is the distended bladder of the patient, full of residual urine, as I informed you previously.” Without any difficulty I passed a Thiemann catheter into the bladder, emptying more than two pints of urine. By rectal palpation I found that the prostate was hardened and enlarged. My diagnosis was right. I advised the patient to have clinical treatment for about three weeks. He confidently agreed. The treatment was successful. I immediately put a permanent catheter through the urethra into the bladder, irrigating the bladder twice a day with a solution of Arnica. Every morning and evening an enema with Natrum muriaticum. The first two days only liquid food, mineral water, and juices. Twice a day Arnica 6x and Nux vomica 6x alternating. During the first week the tongue cleaned, became moist, not coated al all, appetite excellent, blood pressure 195, pulse improved; general feeling of the patient much better than ever before during the last ten years. At the end of the second week the patient felt quite another man. All his troubles had gone. I removed the catheter; though the function of the bladder was much better, there were still 12 pints of residual urine. The congestion of the prostate was also much better. I taught the patient how to use the catheter, suggesting that he should catheterize every evening before going to bed. During the following weeks the recovery of the patient continued, he was able to work, he gained 21 lbs., his general feeling of content was excellent, his appetite increasing from week to week. He passed his urine three times a day, using every evening the catheter and slept the whole night without any interruption. After eight months his bladder was strengthened, containing only a few drops of residual urine. Blood pressure 175. I thus discontinued the use of the catheter, giving the patient times a day, 10 drops. This prophylactic treatment was very successful indeed. The patient never had a relapse of his disease, but neither he, nor his doctor could understand the miracle of such a perfect cure after such a long period of a progressive cachexia.