Folk medicine yields little in reference to kidney ailments, although there are occasional references to bladder disturb­ances, difficult urination, or conditions involving dropsy, which may be caused by kidney disease.

During the latter part of the last century, plasters shaped in the outline of the kidneys were used extensively, plastered to the back, usually in an effort to relieve a back pain that in many cases had nothing to do with a kidney ailment.

Most familiar kidney disorder to the public probably is Bright's disease, which actually may mean any kidney in­flammation.

A typical treatment for "Bright's disease" might be ob­served in the case of Tom Kirkson, 52, a laborer who com­plained of nausea, a pain in the back and a headache. A puffiness of face and legs also indicated a dropsical condition.

The Kirksons lived in a small South Dakota town where there was no doctor in this year, 1880. However, Mrs. On-braughton, wife of the town's merchant, had a vast number of home remedies ready for almost any illness.

After consulting the household doctor books she had on hand, and several almanacs, she diagnosed the case as "Bright's disease."

"What shall we do for it?" Mrs. Kirkson asked.

"First of all we'll grind up some mustard," Mrs. On-braughton announced. "Then we'll mix it with cold water. We'll put it over the small of Tom's back—right over the kidneys."

"But won't it blister?"

"That's the trick! We take it off before it blisters."

"That's all?"

"Goodness gracious, no! Then we must wet a cloth in oil and put it over the spot until the redness goes. Then we start all over again."

"Are you certain it will help?"

"No, but if the pain continues I looked up a prescription I think we can make."

"You mean from the drugs you keep at the store?"

"Yes. We'll use a tincture of aconite root, a tincture of arnica and some laudanum. We'll mix it and put it on with a cloth."

"I'm so grateful, Mrs. Onbraughton."

"Nonsense. What else are neighbors for but to help? And there's more. It's a little delicate—but I looked it up and we'd better talk about it."

"Yes?"

"His passing water. He should avoid it, the book says. I mean, we shouldn't give him anything that will make him pass more than usual."

"Is there a way?"

"The book says fluid may be carried away by the bowels. They mention podophyllin and cream of tarter. But I don't have the podophyllin."

"Heavens! I don't see how you can remember about these things! Is there something else?"

"I've studied drugs and herbs a great deal. They're very interesting. And we can give Tom some calcined magnesia in lemonade. And ... I almost forgot—all he should have to eat or drink is milk."

Tom Kirkson recovered from his ailment, but he told his wife, confidentially, several weeks later, that he was certain he had suffered from "an old-fashioned cold." In all probability he was right. Nevertheless the treatment as prescribed by Mrs. Onbraughton was popular for kidney ailments in those years.

In 1920 a home remedy book of long standing printed the following emergency treatment for convulsions from uremia caused by the failure of the kidneys to function: "Send for medical assistance. In the meanwhile apply cold to the head and mustard plaster across the small of the back; place the patient in warm blankets, and apply hot water bottles to his feet and around him, the object here being to encourage sweating."

Although the advertisements for kidney plasters frequently showed a sufferer holding his back in the vicinity of the kidneys as if in great pain, there actually is little pain, if any, with some of the most serious kidney disorders. This excludes, of course, the pain experienced in the presence or passage of a kidney stone.

Some of the old-fashioned treatments suggested for kidney stones included a free use of alkalies to counteract the acidity of the urine, and a free use of soothing drinks of flaxseed or slippery elm with sweet spirits of nitre, or bicarbonate of soda.

Midwest pioneers occasionally resorted to a dropsy treat­ment that included sliced horseradish tied to the patient's feet, or an external and internal dosage of powder made of toads.

When inflammation and congestion of the kidneys was suspected, free cupping or leeching over the seat of pain was frequently recommended, along with purges and warm hip­baths. The suggested diet consisted of slippery elm mucilage, flaxseed tea or a tea made of quince seeds.

For many centuries the relationship between the kidneys and disposal of body wastes has been recognized. The kidneys were described in ancient medical writings. Basic functions were observed to the extent that urine leaves the kidneys, travels down a duct (ureter) from each of our two kidneys to the urinary bladder.

The kidneys themselves are about the size of a fist, shaped like beans. They are located on each side of the back portion of the abdomen. In recent years researchers have discovered that they are far more than part of a routine waste-disposal system.

We know today that the kidney functions are so complex, delicately balanced, unerring and important, that the kidneys may be regarded as one of the most important control centers in the body. Kidney diseases rank fourth as the cause of death in this country.

In addition to cleaning better than a ton of blood a day in the average, normal person, the kidneys control our mineral balance, maintain an exact proportion of water and minerals in the blood, and keep the acid-alkali balance just where it should be even as they do their job of disposing of urea.

These are most important functions. If the mineral balance should get out of line—too much potassium, for instance— death could result. Too much of a swing one way or the other in the acid-alkali balance could kill. If urea that they dispose of is allowed to accumulate because of kidney shutdown, death results.

Each kidney has approximately a million to a million and a, half nephrons, which are the kidneys' functioning units. A nephron is a threadlike structure barely visible to the naked eye. Through a complex process the nephrons take up glucose, proteins, amino acids and minerals that we need and they cast away waste and excess water.

If the kidneys cease functioning and stop secreting urine, the result is lethal unless the kidneys can begin to function again.

Fortunately, nature has given us extra protection. For one thing, it is estimated that normal kidneys can handle about nine times the capacity actually required of them. They usually are hardy and give little trouble in relation to the complex job they do. Most reassuring of all is the fact that we can get along very well with only one healthy kidney, so we usually have—in effect—-a spare.

For some reason not fully understood, kidney stones may form in the kidneys. A stone may remain in a kidney and produce no symptoms, and if it is discovered it usually is through examination for some other condition.

It may remain in the kidney and cause pain with the pos­sibility of infection resulting—usually apparent on examina­tion of the urine, or because of urinary bleeding. Or the stone may remain in a kidney and grow to the extent that progres­sive deterioration of the organ results. Sometimes the function

of the kidneys is destroyed by a stone, and stones have been known to grow several inches in diameter—called staghorn or coral stones—to completely fill a kidney.

A stone may leave the kidney ("passing a stone"), travel into the kidney tube, called the ureter, and to the bladder. When this happens the patient frequently suffers excruciating pain. Fortunately about 80 to 90 per cent of the stones pass successfully. When they do not—in 10 to 20 per cent of cases —an operation is necessary.

There is no way to dissolve or crush the stones in the kidney or ureter. They may be removed by surgery, or by using a delicate method of inserting a small tube, with a basket at the end, into the urinary tract, through the bladder, and into the ureter which may be blocked by the stone. The stone is caught in the basket and removed in this non-surgical procedure.

Operations for kidney or ureter stones are not considered to be dangerous. Recovery is expected in almost all cases, the exception being mostly with persons who have marked kidney damage on both sides.

Stones may recur in between 15 to 25 per cent of all cases, according to reports from surgeons.

Bright's disease, the disease most commonly associated with the kidneys, is named for a British physician of the 19th century. It means kidney inflammation, which can be brought about by a number of things. Injury may cause it, poisons, toxins released by bacteria somewhere else in the body— diphtheria, sore throat, scarlet fever.

Kidneys may harbor tumors, both malignant and benign. Wilm's tumor is a cancerous growth within the kidney, found in young children, and must be removed early in its develop­ment to save a child's life.

Surgeons warn that there are three main signs that should cause us to seek a doctor as soon as possible: 1. An ache in the loin over the kidney area. 2. Blood in the urine. 3. The feeling that there is a mass or lump in the kidney area.

Since World War II artificial kidneys have been so per- fected that they are becoming virtually standard equipment in better-equipped hospitals.

In many cases where kidneys have shut down following burns or accidents followed by shock, the kidney machines have been pressed into action. The patient's blood is circu­lated through the machines which partially take over the kidneys' job until they are functioning again.

Partial shutdown of kidneys usually results in a water­logged condition—dropsy—which now is amazingly well handled by several types of diuretic drugs, in pill form, that cause an increased flow of urine.

Steroid therapy is showing effectiveness in controlling ne-phrosis (degeneration of the kidneys) in children. New methods of detecting pyelonephritis, an infection that destroys nephrons, enables physicians to cut down fatalities from the infection because the infection can be eradicated, in time, by use of drugs. Previously, it was one of the most difficult of infections to diagnose in its early stages.

Beyond the use of surgery for kidney stones, tumors, and cysts, surgeons have gone into new and exciting fields in kidney operations.

Kidney defects present at birth in children are being cor­rected by surgery with considerable success.

Dr. Hans Zinsser of Columbia-Presbyterian Medical Center, says about this work among children: "One of the most im­portant projects in the field of kidney diseases is to perfect ways by which we can anticipate, prevent, and treat the con­genital defects at the earliest possible moment."

Probably the most dazzling kidney surgery in recent times has been the successful kidney transplant from one person to another.

Although the idea of transplanting is by no means new, for years surgeons failed in attempts because antibodies de­stroyed the "foreign" tissue of the transplant when it was put into a body.

Three Boston specialists, Drs. Joseph E. Murray, John P. Merrill, and J. Hartwell Harrison came up with the idea that a successful transplant might be possible between identical twins inasmuch as they are almost exactly alike in their chemical constitution.

What happened is, of course, surgical history. In December, 1954, a former Coast Guardsman was brought to Boston with both kidneys destroyed by disease. Ordinarily the prognosis would be negative. There wouldn't be a chance for him to live. In his particular case, however, there was a chance. He was an identical twin. A transplant might be successful.

The surgeons removed the left kidney from the patient's healthy brother and installed it in the right side of the ill brother.

The operation was a success. Since then others have been similarly successful.

This was not the answer to the problem for others, however. It only worked for identical twins.

The Boston specialists approached the problem from another direction. When given massive doses of radiation the body's ability to produce antibodies is temporarily suppressed. If this were done before a transplant, perhaps the weakened antibody defense would allow the body to accept the trans­planted organ while the defense recovered.

This time the experiment was conducted between two fraternal twins—not identical, and comparable to the condi­tions between any two persons—and apparently the operation has been successful as the patient was in good health a year and a half after the surgery.

Other experiments along the same line are showing good results, and intensive research to find suitable drugs to sub­stitute for massive X-ray dosages is very promising.

Meanwhile the complex importance of the kidney finally has been recognized and there is every reason to hope that kidney diseases soon will be materially on the wane.

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