Diuretic

“ A Diuretic effect is very frequently occasioned by substances which act on the stomach and primæ viæ, producing a peculiar state of these organs, which sympathetically affects the whole body, and more particularly the absorbent system, and the vessels concerned in the secretion of urine from the blood. As this primary influence upon the stomach, and the effects to which it gives rise in remote parts, are very different in their character, according to the nature of the remedy employed, and the state of the system at the time of its administration ”

“ Potassium Bitartrate: as hydragogue cathartic and diuretic.
Potassium Bromide: in uremic convulsions.
Strontium Acetate.
Strontium Lactate: if due to renal atony.
Tannalbin.
Tartrates: as diuretics.
Turpentine: as diuretic, 1/2 to 1 minim dose every two to four hours.
Water: in large draughts as diuretic when excretion of solids is deficient; and in dropsy.
Alcoholism.—See also, Delirium Tremens, Vomiting, Neuritis.
Actæa Racemosa: in irritative dyspepsia.
Ammonia: aromatic spirit of, as substitute for alcohol, to be taken when the craving comes on. ”

“ In India the decoction is given internally, 200–250 grams, for hypertrophy of the liver, and it is considered a good diuretic and alterative. For such uses they heat the above dose in a clay vessel till the color changes from green to brown, when it is cooled and given next day. Its action is diuretic and hydragogue-cathartic. Mooden Sheriff recommends this treatment highly, and for dropsy further advises the aqueous extract, 12 grams during the day divided into 3 or 4 doses. ”

“ Solubility. Water and alcohol alike extract their 481active matter. Med. Uses. They certainly act as a powerful diuretic, and even prove so to animals that browse upon them. I have frequently exhibited them in the Westminster Hospital, with very great success in the form of decoction. By referring to my classification of diuretics, page 93, it will be seen that the Broom is placed under the second division of the first class; for analogy sanctions the theory, that the bitter element is separated by the powers of digestion, and carried to the kidneys by the medium of the circulation. ”

“ According to the dose, and circumstances under which it is administered, it proves expectorant, diuretic, emetic, or purgative; as an expectorant, it can never be employed where pulmonary inflammation exists, for in such cases, instead of promoting, it will check any excretion from the lungs; its combination with a diaphoretic will frequently increase its powers, and generally be a measure of judicious caution. ”

“ If only we could largely increase the secretion of urine, the pressure on the venous system would be diminished, and absorption of the effused fluids might take place. In some cases of dropsy caused by renal congestion, the attempt is so hopeless that it is better to resort to Diaphoretics. In obstruction on account of heart disease, or congestion of the liver, we may sometimes gain our point by combining other Diuretics with Digitalis or Blue-pill, remedies which tend to remove the causes by which the diuretic action is hindered. ”

“ I have elsewhere remarked, that when the Digitalis has been properly given, and the diuretic effects produced, that an accidental over-dose bringing on sickness, has stopped the secretion of urine. In the present instance it likewise appears, that violent sickness may be excited, and continue for several days without being accompanied by a flow of urine ”

“ For persons suffering from violent falls, three ounces of the seed is recommended. A pound of oil, in which rue leaves have been boiled, added to one sextarius of wine, forms a liniment for parts of the body which are frost-bitten. If rue really is a diuretic, as Hippocrates1549 thinks, it is a singular thing that some persons should give it, as being an anti-diuretic, for the suppression of incontinence of urine.
Applied topically, with honey and alum, it cures itch-scabs, and leprous sores ”

“ A further factor is suggested by the action of certain diuretics. In the kidney the changes in the quantity of blood flowing through the organ and to some extent changes in blood pressure influence the flow of urine. The diuresis produced by such substances, however, as saponin, digitalin, potassium chlorate, etc., probably depends on an increase in permeability of the capsule of Bowman. As shown [91] recently, these substances produce haemolysis, and are also strong diuretics. Calcium chloride, which inhibits the flow of urine produced by them, inhibits also the haemolysis. ”

“ The lung is more or less collapsed and the right heart dilated and attenuated.
Treatment must be in the main tonic, diuretic and derivative. Food must be nourishing, digestible and in liberal amount; diuretics and bitter tonics with digitalis and, (if there is little fever) preparations of iron are to be pushed as far as the strength will allow; and the counterirritants applied to the sides of the chest a number of times in succession. Iodides may be used internally and externally, and paracentesis must be employed unless early improvement is manifested. ”

“ A solution of the same strength is injected to overcome acidity of the uterus in leucorrhoea, etc. Calculus made up of ammonium, magnesium and phosphates occur in the bladder and urethra of highly fed rams and wethers. For this use potassium bicarbonate one-half to one drachm, well diluted, conjoined with laxative diet and belladonna to dilate urethra; it is less certain as a diuretic than the acetate or nitrate of potassium. ”

“ In these cases however, if an acid acrimony abounds in the stomach and bowels, with a costive habit, and pale complexion, Magnesia will be a useful corrector, and entering into [Pg 38] the circulation in the form of a mild neutral salt, may act as an excellent alterative, [n] proving both diaphoretic and diuretic. ”

“ The same remedy may act in more than one way, e.g. alcohol, besides stimulating the secretory organs directly, is a stimulant to the circulation, and thus increases the pressure within the vessels. Diuretics are prescribed when the quantity of urine is much diminished, or when, although the quantity may be normal, it is wished to relieve some other organ or set of organs of part of their ordinary work, or to aid in carrying off some morbid product circulating in the blood, or to hasten the removal of inflammatory serous exudations, or of dropsical collections of fluid. ”

“ One of the most constant symptoms produced in man by over-doses of caffein is excessive diuresis, and experiments made upon the lower animals show that caffein acts as a diuretic not only by influencing the circulation, but also by directly affecting the secreting cells, the probabilities being in favor of the first of these theories of action. ”

“ I think I have generally observed, that when the remedy has been pushed to such an extent as to excite the salivary glands to excessive secretion, the urinary organs cease to participate in its stimulating action, and vice versa, for the mouth is rarely affected when the mercury runs off by the kidneys; this may suggest a precaution of some practical moment in the treatment of dropsy, and it will be generally judicious to accompany the administration of this metal with certain diuretics, in order to direct its operation to the kidneys ”

“ V. That in proper doses, and under the management now pointed out, it is mild in its operation, and gives less disturbance to the system, than squill, or almost any other active medicine.
VI. That when dropsy is attended by palsy, unsound viscera, great debility, or other complication of disease, neither the Digitalis, nor any other diuretic [192] can do more than obtain a truce to the urgency of the symptoms; unless by gaining time, it may afford opportunity for other medicines to combat and subdue the original disease. ”

“ Under this class of medicinal agents it may be observed that, whenever a medicine is liable to produce effects different from those we desire, its combination with similar remedies is particularly eligible, by which the action of the basis may be directed and fixed; thus the individuals which compose the class of Diuretics are uncertain in their operation, and disposed when exhibited singly to produce diaphoretic, and other contrary effects ”

“ This formula is introduced, as a combination supported by authority, although it may be questioned whether its adoption can be sanctioned upon principle. Let us decypher the intention of the different ingredients by their Key Letters. The basis is Squill, to which Digitalis is added, for the purpose we perceive of acting in unison with it, and Calomel, which succeeds it, is intended to promote and direct the diuretic Basis ”

“ Tincture of Cantharides and Acetate of Potash, both diuretics, have been employed in Lepra to eliminate the materies morbi from the blood into the urine, and have sometimes appeared to succeed in so doing. But in this, as in many other cases, counteraction is both easier and more certain than elimination. The system itself naturally attempts this elimination, and when it finds it impossible, we often gain nothing by urging it. ”

“ The mechanical cause of the obstruction to the venous circulation cannot be removed, and it is not only the functions of the kidneys that are disturbed, but those of the lungs, liver, spleen, stomach, and small intestine. Still, we can do something. The iodide of potassium, convallaria, caffeine, and digitalis may be of service in equalizing and strengthening the heart's action, and at the same time act as diuretics. Inhalations of the nitrite of amyl dilate the arteries and capillaries, and so unload the veins. ”

“ Nutritious diet, frequent alkaline baths to keep the skin in good condition and favor excretion through its pores, and a general hygienic regulation of the daily habits, are of the greatest importance. There are also a few general remedies which may prove more or less beneficial in nearly all cases. We refer to diuretics and hydragogue cathartics. The object sought in the administration of these is the evacuation of the accumulated fluids through the kidneys and bowels, thus giving relief. Of the diuretics, queen of the meadow, buchu, and digitalis generally operate well. ”

“ The kidneys are the chief emunctories of water; and mineral substances which are soluble in water tend for this reason to pass out into the urine. Many of these, as the salts of Iron, Silver, Lead, and Copper, are Astringents, and tend to diminish rather than to increase the amount of urine. But the urine is so necessary and so constant a secretion, that it is very difficult to diminish it in quantity. Saline medicines act as Diuretics under certain conditions. So also do acids and alkalies, and many vegetable substances, which will be presently spoken of. ”

“ I beg to refer the practitioner to some cases published by me in the Medical and Physical Journal for December, 1809, in further illustration of these views. Experience enables me also to state that Diuretics are considerably assisted by similar means, having many instances in my case book of the failure of these agents before, and their successful operation after, the exhibition of a cathartic. Dr. Darwin observes that “Absorptions are always increased by Inanition,” and in support of this position refers to the frequent advantage derived from evacuations in the cure of ulcers. ”

“ The free acids, both mineral and vegetable, with the exception of Sulphuric acid (vide p. 262,) pass into the urine, and act as Diuretics. So also do the mineral alkalies. But as these medicines have important agencies in the blood, and tend further, by altering the reaction of the urine, to produce in it deposits of different kinds (vide p. 151,) they can seldom be safely employed for this purpose. Salines are more appropriate. They should not be given in large doses, for they will then act upon the bowels. ”

“ Gentle DEOBSTRUENTS, which additionally excite the secretion, and promote the discharge of urine, are known to act upon the motion as well as the property of the BLOOD, by stimulating the solids, and quickening their vibrations, thereby increasing the blood's velocity, and promoting its attenuation. Hence it is, those diuretics recommended by Bracken are peculiarly adapted to this, and such other disorders as originate in sluggish viscid habits, where the blood becomes too adhesive for regular circulation. ”

“ If the skin be kept warm, most of these medicines promote sweat instead of urine; and if their dose is enlarged, most of them become cathartic. Hence the neutral salts are used in general for all these purposes. Those indeed, which are composed of the vegetable acid, are most generally used as sudorifics; those with the nitrous acid as diuretics; and those with the vitriolic acid as cathartics: while those united with the marine acid enter our common nutriment, as a more general stimulus. All these increase the acrimony of the urine, hence it is retained a less time in the bladder ”

“ IV. Violent diuretics. 1. If nitre be given from a dram to half an ounce in a morning at repeated draughts, the patient becomes sickish, and much pale water is thrown into the bladder by the inverted action of the urinary lymphatics. Hence the absorption in ulcers is increased and the cure forwarded, as observed by Dr. Rowley.
2. Cantharides taken inwardly so stimulate the neck of the bladder as to increase the discharge of mucus, which appears in the urine ”

“ Crossing with a strange male having many of the desirable qualities of the herd, but which is more vigorous may be resorted to. When the secretion of urine becomes scanty an abundance of pure water, or a diet of succulent grass or roots or ensilage or even small doses of alkaline diuretics may be resorted to. Any source of arsenic or phosphorus poisoning should be cut off, and as an antidote to phosphorus, oil of turpentine may be given in small doses. This agent may, indeed, replace the alkalies as a diuretic, bringing in an element of tone for the mucosa which is not to be despised. ”