BRIGHT’S DISEASE (ALBUMINURIA).
In its later stages, this is one of the worst forms of disease. It is
often said to be caused by “cold.” There can be no doubt but what a person
whose kidneys are already badly diseased, and, consequently, his whole
system depraved, may have a violent illness excited by extreme exposure to
wet and cold. The same may be said in case of one reduced by any
exhausting form of disease; but sound-bodied men, living hygienically,
could never have this disease, whatever the degree of cold they might have
to endure. On the contrary, this disease is not known among the residents
of the polar regions; our own explorers among the ice-fields of the north
do not have it, although exposed for long periods to a temperature at 40°
to 60° F. below zero, and to changes of so extreme a character that our
temperate climate affords no parallel to them. “In the accounts of Arctic
expeditions, though the most intense cold was often endured, under
circumstances of great fatigue, by men previously weakened by disease and
hardship, this is not among the diseases from which they suffered. Dr.
Kane’s men, though enduring extreme cold, exposed on one occasion for
seventy-two hours at a mean temperature of 41° below zero, suffered
fearfully from frost-bite and scurvy, but not from any renal affection.
Other travelers within the Arctic circle bear the same testimony, and I
have been informed by those familiar with the cold districts of North
America, that there renal dropsy is unknown.”[41] “The travelers in the
frigid zone are exposed to far greater and more sudden transitions of
temperature than are ever felt in our changeable but temperate climate.
Capt. Parry states that his men often underwent a sudden change of 120°,
in passing from the cabin of the vessel to the outer air, and yet none but
the most trifling complaints resulted. Here we have all the circumstances
from which experience would lead us to anticipate renal disease, viz.:
great preceding depression, intense and protracted cold suddenly
applied.... Extreme cold,” continues Dr. Dickinson (ibid.) “though it may
stop cutaneous exhalation, probably does not allow the material that would
cause renal inflammation to accumulate. Cold increases the action of
oxygen and gives rise to increased combustion of the solids and fluids of
the body. This condition, as I have emphasized elsewhere repeatedly,
occasions a demand for a large amount of food daily, to supply the waste,
and exalts the digestive powers correspondingly. The moral of all this,
for those who, living in a temperate climate, would avoid these
disorders——all physical disorders, indeed——is that _here the above
conditions can not obtain to the extent of rendering possible the
digestion_ and _absorption_ of _three full meals a day_. Only under
exceptional circumstances are _two_ such meals ever thoroughly digested
and assimilated——they can never be, unless needed; and this fact is not
disproved simply because inexperts do not recognize the symptoms of
indigestion which everywhere prevail among themselves. Some of the most
incorrigible workers, with both brain and muscle, known to me, take but
_one meal a day_,[42] and this because they found the change necessary in
order to enable them to perform their arduous labors and preserve their
health. Others similarly situated divide this meal into _two
halves_——taking a small meal morning and night, or, better than the
latter, a lunch in the morning, and at night, after ample rest, the
principal meal. No person ever tried this plan and found any need of a
change because of lack of nourishment.[43] I mention this last point to
meet the stock objection of people who essay to escape from the logic of
the position——the necessity for the modification of their own dietetic
habits——behind the old dogma, ‘one’s meat is another’s poison.’ (See p.
43.) It is entirely probable that a robust man (a frail one would succumb
to the exposure, with or without food) exposed for days together, and for
the entire twenty-four hours, to the extreme cold of winter, exercising
vigorously meantime, could eat three full meals a day and escape digestive
disorder. The habit of approximating as nearly as possible to this diet,
in a temperate climate, or while the bodily warmth is maintained by
artificial heat, originates the greater proportion of our ailments; while
lack of exercise, and the folly of attempting to oxygenate this excessive
quantity of food with air that is breathed over and over again——a process
which one writer likens to eating one’s own fœces——amply accounts for the
balance.
[Footnote 41: “Treatise on Albuminuria,” by W. Howship Dickinson, M.D.,
F.R.C.P., etc., p. 54.]
[Footnote 42: See note on The One-Meal System.]
[Footnote 43: The fact is——and it can not be made too
prominent——ninety-nine in the hundred, of all classes of people, eat in
excess of their needs, and the “small eater,” eating without appetite,
eats, relatively speaking, more excessively than the gross-feeder whose
appetite never fails.]
“By cold the respiratory function is exalted, and the excretion of urea is
diminished. With the intense cold of the North Pole (and in the _open
air_), the introduction of oxygen by the lungs is probably so great, and
the oxidation in the body so active, that all material susceptible of such
action becomes oxidized, as much of it as can be converted into carbonic
acid passing out with the breath. The kidneys, therefore, are not liable,
as in temperate climates, to be irritated by excrementitious matter, for
the stress of excretion falls upon the lungs.” (Ibid.) The practical
question then is, What can we do, in this particular climate, that shall
tend to give us exemption from a disease that can not exist at the poles,
where the cold is intense enough to require a man to eat all he can, nor
at the tropics, when the heat is met with a diet of juicy fruits?[44] (See
article on Fruits.) Simply this, and nothing more; so regulate the diet
as to forbid indigestion, or, in other words, eat according to our needs,
as governed by work and weather; and all that has been said about the
cause and prevention of “colds” (see C.) is applicable right here.
[Footnote 44: Sojourners from the North, at the tropics, are exempt from
disease so long as they live on the fruits of the soil; but a beef and
brandy regimen makes short work with them.]
Winter weather (inoperative, however, for those who spend their time in
close, warm rooms), scant clothing, much exercise, fresh air——these
conditions, so far as present, and to the extent of a man’s subjection to
them, require a larger quantity of food than could be digested under
opposite conditions, and tend to mitigate the effects of over-indulgence
as to amount and quality. In our climate, however, not one person in ten
thousand lives, even in the coldest weather, sufficiently under these
influences to require the diet necessary at the poles, viz., three full
meals of mixed food, largely composed of fat. Hence, the only palliatives
a person can resort to, who adheres to the prevalent mode of living, as to
diet, are those conditions that approach as nearly as possible to those
obtaining in the frigid zone; but these conditions can not be, at least
are not, enjoyed here, to a point rendering exemption from disease
possible even for the most robust. But when we reflect upon the fact that
our people are not, as a rule, robust (although this would be otherwise
but for the unbalanced circumstances under consideration), that they live
in warm rooms, wear heavy clothing even within doors, and don thick wraps
on going out, work as little as possible (all tending to the need of
abstemiousness), and that in the face of all this they do not, at least to
any appreciable extent, voluntarily restrict their appetites, but do, in
fact, even in summer, imitate the blubber-eaters of the North, nearer than
they do the fruit-eaters of the South; that Sabbath morning finds the New
Englander, for example, gorging himself with pork and beans, hot brown
bread dripping with butter, hot, strong coffee, etc.; Tuesday, roast-beef,
with plenty of gravy; Wednesday——“boiled mutton, with caper sauce,” and so
on to Saturday’s boiled dinner, of corned-beef, greasy cabbage, etc. (the
diet of the poor differing chiefly in the quality, or price per pound),
and this just the same during the warmest week in winter as during the
coldest, and regardless of any of the possibly varying circumstances, as
hard work out of doors, or light work, or none at all, within; and that
this same folly runs into and becomes greater folly in the spring and
summer even, except so far as nausea or lack of appetite cause an
involuntary modification,——in view of all this we need not look
altogether, nor indeed at all, to heredity to account for the wretched
disorders to which we, as a people, are subject, and which prevail to an
extent almost transforming our literary and art periodicals into indirect
partnership-relations with the manufacturers of quack “remedies” for all
forms of sickness; this class of advertisers _pay_ too liberally to
exclude their flaunting lies. I look almost in vain for even a religious
journal that refuses to devote any portion of its space to medical
advertisements. Do our religious editors themselves believe in, and take,
the “pills” they advertise?
Bright’s Disease is one that never attacks those who live on coarse food,
live abstemiously, and drink water chiefly. It is rather a disease of
“high livers.” But a man does not need a large income to ensure this
affection: any one who can get all he wants to eat and drink, and who eats
and drinks all he “wants” (even without indulgence in wine, or alcohol in
any form, which is a prolific cause of this disorder), may safely reckon
on some of the symptoms, if not upon the worst form of the disease; and
whether it be the understood cause of his death or not, it will surely be
a contributing cause. The possession of typically healthy kidneys is a
rare circumstance in this climate. The excessive micturition so universal
in infancy, occasioned by excess in diet, is the beginning of renal
disease.
Dr. Bright immortalized his name by discovering the fact that, when a
man’s last sickness is attended with a certain class of symptoms, as
albumen in the urine, final suppression of the urine, and uremic
poisoning, they are occasioned by a peculiar disease or degeneration of
the kidney. From a practical stand-point we care nothing about the kind of
change taking place in the kidney, but rather ask what kind of change in
our habits will keep this, and all the organs of the body, in a healthy
condition? The former study is all well enough for those who desire it,
but if _too much time_ is devoted to it, and to the _relation of drugs
thereto_, by an individual, he may be, probably will be, the very least
fitted to advise an inquirer who desires to know what he can do to be
saved from disease and the supposed necessity of taking medicine. Says Dr.
Dickinson (ibid., chap. VI.): “There are few disorders which are more
under the influence of medicine than is the catarrhal inflammation of the
kidneys.” And the very next sentence is one worth pondering on by those
who are accustomed to take medicine whenever they come to grief through
ignorance or neglect of the laws of life: “Under some plans of treatment,”
says this celebrated authority, in continuing, “plans which formerly were
almost universally adopted, and _still have their advocates_, the disorder
is one of heavy mortality. Under other circumstances the danger is so
small, that if once the complaint be recognized, a recovery may be
reckoned upon in a large _proportion_ of cases. Without treatment of any
kind there is reason to suppose that a large _majority_ of the subjects of
it would recover.” (The italics are my own.) From this it will be observed
that it depends on one’s luck whether he shall fall into the hands of a
practitioner who belongs to a class still adhering to the plan ensuring a
“heavy mortality,” or of one whose modified form of treatment is less
fatal; and upon his good sense, whether he shall come under the influence
of either, or adopt the methods indicated herein, viz., the abandonment of
disease-producing, and the adoption of _ease_-producing, habits, which
would be an immense gain over the “no treatment” plan which, according to
a rational interpretation of Dr. Dickinson’s language, is the safest of
the three referred to by him. From the three-hundred-page treatise before
me, which is fresh from the mint (1881), and is a most valuable book for
those who wish to study the pathology of the disease (Bright’s), but which
is little calculated to aid any one healthward, except he be already
pretty well informed in hygienic matters, I cull, in addition to the
paragraphs already quoted, the following little nugget of pure gold: “We
must avoid the use of any drugs which, under the name of stimulating
diuretics, might exasperate the existing congestion; and we must enforce
such diet as to reduce to a minimum that nitrogenous excess which finds
its way out chiefly by the kidneys, and provides in many shapes effective
means of irritation. Physiological repose is to be sought, not by
debarring the gland of the harmless and necessary solvent, but by cutting
off the materials of urea and uric acid.” How naturally, then, do we look
for the continuing sentiments: “‘Spare diet and spring water clear’ may
often be found sufficient though simple remedies. _Of all diuretics water
is the best._”[45] But how can we reconcile, with such counsel, the
treatment that he himself commonly adopts?
[Footnote 45: Ibid., p. 86. The italics are my own, and I am amazed to
find that this best diuretic is rarely the one used, and never fairly
tested by this authority, who seems almost to exhaust the _materia medica_
in the treatment of even infants of tender age.]
In one case noted by him, and in which, as he says, “the attack was
slight,” and “the boy became convalescent,” but later, although under the
doctor’s own eye at the hospital, with “no evidence of his having taken
cold,” he became worse, went on to a fatal termination, “the urine
becoming loaded with albumen and abounding with fibrinous
casts——convulsive attacks——death!” It seems to me easy enough, however, to
reconcile the unfavorable turn and the fatal termination with the
treatment he adopted, viz., digitalis instead of “the best diuretic”
(water); “fluid diet,” consisting chiefly of beef-tea——a non-nutritive
fluid whose solid constituents are mainly urea, kreatine, kreatinine,
isoline, and decomposed hæmatine, exactly the animal constituents of the
urine, except that there is but a trace of urea.[46]
[Footnote 46: London _Lancet_.]
As the little fellow grew worse, “a little brandy was given to counteract
the depressing effect of the digitalis.” “On the 27th, the pulse had
fallen to 52, and was not quite regular; the brandy was therefore
increased to two ounces daily,” with digitalis every six hours; later, a
“diuretic draught composed of scoparium, acetate of potash, and nitric
ether; on the 29th, this diuretic mixture was changed by the addition of
nitre and squills; on the 30th, as was anticipated, he was seized with
eliptiform convulsions, a succession of which came on, accompanied with
foaming and biting of the tongue, and caused his death in two hours and a
half.”[47] The next case reported was that of a child eighteen months old,
treated at the hospital by the same physician, and described:
“Dropsy——persistent diarrhœa——peritonitis——death.” “The child,” says the
celebrated practitioner and author, “was frequently fed with pounded meat
and milk; a little brandy was given, and opiates and astringents were
prescribed to check the diarrhœa.” As he went on to his fate, he was made
to swallow the following remedies: “opium, dilute sulphuric acid, tincture
of the sesquioxide of iron, acetate of lead. The quantity of brandy was
increased to three ounces daily. The child became paler and had a sunken
look,” etc. “The child sunk a week after admission.” I make mention of
these cases for the reason that up to this day the same horrible treatment
is being practiced. Although these, and many even worse cases contained in
this new work, transpired some years ago and were recorded in the first
edition, still they remain in the new edition unaccompanied by any note of
warning; and young or old medical students pore over and imitate the
examples here set before them.
[Footnote 47: The case of Thomas Vallance, 9 years old. Oh, wise
physician: the fatal symptoms came along “as anticipated!”]
I quote another paragraph from the treatise of Dr. Dickinson, which, if it
has, as would seem evident, thrown little light about the doctor’s own
pathway, as regards the appropriate treatment of the disorder, will prove
instructive to some of my readers, and bear favorably upon my theory of
disease. In the early pages (p. 29) of the treatise, Dr. Dickinson says:
“It may be generally stated that this inflammatory disease arises from
unnatural stimulation of the kidneys. The blood is charged with [food]
material excessive in quantity or unnatural in quality, which these
glands take upon themselves to remove. Their own proper elements of
secretion are poured upon them in sudden and excessive amount, or matter
is thrown upon them which is foreign to their usual habit. As a
consequence of overwork, or of work to which they are not adapted, they
take on a turbulent and abnormal activity. They become congested, the
tubes get choked up with epithelial growth, and the disease is
established.”
Many of the symptoms in the following list are more or less frequently,
some of them invariably, present in the case of supposably healthy
infants, and are commonly considered as entirely normal. Fairly
considered, however, they are the effects of excess in diet. To the
greatest possible extent the superfluous water contained in their gross
diet passes off by the kidneys, causing immediately a diseased condition
of those organs from overwork; the cellular tissue becomes loaded and
distended with the fatty matters, and also with much water, unrecognized
as dropsy until it reaches immense proportions; what really amounts to
purging is so universal as to be regarded as the normal state of an
infant’s bowels, and this is, sooner or later, often very early, succeeded
by the reaction termed constipation. The back-aching that results from all
this is none the less terrible because the little sufferers can not talk
and tell where the pain is; peevishness, general _malaise_, and crying,
tell of suffering, not of (their) perversity. Among the
SYMPTOMS OF KIDNEY DISEASE
are the following: frequent and copious micturition (wetting the bed or
getting up at night); later the excretion of urine is scant, passed
frequently, or, may be, suppressed altogether. Fat; later——emaciation.
Heat and dull pain in the loins[48] (small of the back), increased by
pressure; slight or considerable “puffing” about the eyes, noticeable only
at times, or it may be constant and unrecognized as a symptom of disease;
it may be diminished at times, as the secretion of urine becomes modified,
or the condition of the system happens, temporarily, to improve. And it
increases often when the secretion of urine diminishes, or is passed less
freely. The countenance is more or less pallid, and may have a brownish
tinge. Croupy breathing accompanies œdema of the larynx. “With children,
inflammation of one or other of the organs of respiration is the most
fatal tendency of the disease. Not only are they liable to pleurisy,
pneumonia, and bronchitis, but, also, to membranous croup.” Constant
tendency to irritability of manner, easily angered, unreasonableness,
petulance; with infants——constant fretting, crying, nothing will interest
or amuse them.
[Footnote 48: Of all portions of the body, this should be lightly covered,
never sweltered with wraps, bindings, or weight of garments.]
Diphtheria is, I believe, only a phase of albuminuria. Says Dr. Grasmuck,
treating of diphtheria, and other physicians have observed the fact:
“Another peculiarity of the scourge is its fondness for children of a
certain condition——the fat, sleek, soft, tender, ‘well-fed’ children so
generally admired——such children can offer but slight resistance to this
disease; being, in fact, chronically diseased, they are predisposed to
‘attacks’ of all kinds; and, living to adult age, furnish the greater
proportion of cases of tuberculous disease. On the other hand,” he
continues, “I do not know of a single instance where the disease proved
fatal to——rarely attacking——a child of the _genus_ ‘Street Arab’——children
who spend most of their time out of doors, are thinly clad, sleep in cold
rooms, have a spare diet, and who have no one to pamper them unwisely.”
Dr. Dickinson treats of albuminuria under three heads, viz., tubular
nephritis, granular degeneration, and lardaceous disease. He designates,
also, such other diseases as are likely to result in consequence of this
disorder; and finds some of these peculiar to, or more apt to afflict,
sufferers from one or the other forms. He says: “It is seen (from the
table presented) that nephritis is a disease of infancy and youth, causing
most deaths in the first decade coincidentally with the prevalence of
scarlatina; many in the third when the toils and exposures of active life
are perhaps the most prolific of evil. Granular degeneration belongs to
middle and advancing life, and is most fatal between fifty and sixty. The
one flourishes upon the febrile accidents [!] of childhood and the
susceptibilities of youth; the other develops when _the habits of life
begin to tell_ and the effects of old age begin to appear. The lardaceous
disorder has little to do with either extreme of the mortal course; it is
chiefly associated with the _vices of early maturity_, and with tubercle
and struma, disorders more incident to the young than the old, and in
their suppurative form to youth rather than childhood.” Among the
diseases resulting, or likely to result, from one or other forms of the
disease, Dr. Dickinson names the following: dropsy, pneumonia, pleurisy,
peritonitis, bronchitis [before mentioned]; pericarditis, endocarditis,
hypertrophy of the heart, with cardio-vascular thickening, [heart
“diseases”]; hemorrhagic accidents [bursting of blood-vessels——apoplexy]
depending as they do upon structural changes of the vessels; diarrhœa.
SOME OTHER SYMPTOMS.
Nasal catarrh; the radical suppression of this discharge is likely to be
followed by serious if not fatal kidney disease.[49] (To remove the former
by removing its cause, thus rendering the discharge unnecessary, is quite
another thing). Hence the danger of using so-called catarrh remedies, or
of adopting any specific local treatment: they are either inert or
injurious.
[Footnote 49: As illustrating this point I will mention the case of M. K.,
of Troy, N. Y.,——a case of successful (?) self-treatment for catarrh. This
patient had for a dozen or more years suffered with nasal catarrh, and had
tried most of the advertised “specifics” without avail; in fact, the
disorder steadily increased. At last, the twice daily snuffing of slightly
soapy water, for some weeks, “cured” him, as he said; but simultaneously
with the suppression of the catarrhal discharge there resulted (without,
however, any thought of connecting the two events, in the mind of the
patient) an excessive flow of urine, extreme thirst, etc., etc.; in short,
true diabetes. In this case great relief was experienced from an exclusive
diet of skim-milk for five months, the patient swallowing nothing else for
that length of time, except two tablespoonfuls, daily, of wheat-bran
thoroughly chewed, “for the bowels.” At the end of the five months the
patient weighed 210 lbs. This he realized as excessive, and my attention
being directed to the case at this point, the patient at my suggestion
adopted the bread and fruit diet——discontinuing the skim-milk and
bran——and gradually reducing his weight by moderate diet and increased
exercise, went on to a complete recovery.]
Erysipelatous inflammation of the dropsical limbs; “vomiting may happen at
any stage, even the earliest; it is often incontrollable.” Head symptoms,
which occur in the more prolonged forms of the complaint, are usually of a
convulsive kind, whereas, in acute cases, coma is apt to set in without
any such prelude. Epileptic seizures may be preceded by pain in the head,
drowsiness, or peculiarity of manner, or may occur without any premonitory
sign.
Says Dr. Dickinson: “The gouty habit, from whatever circumstance it arise,
is one of the more obvious and immediate conditions to which granular
disease of the kidneys can be traced.” ... “The disease is a frequent
result of gout; this is by far the most important fact in its etiology. It
is one of the results of the gouty diathesis (see Rheumatism), and may
precede or follow the external manifestations.... It is scarcely necessary
to insist ... that the gouty condition comes first.” The fact is that
there is a process of degeneration going on throughout the entire
structure of the man, even to the last tissue, and the symptoms are all
indicative of this; and this is more or less strictly true of all
disorders. The naming and classifying of “diseases” is calculated to
mystify and mislead: sickness is the proper term for describing them all;
self-abuse, in the broadest sense of the word, is the cause of them; and
obedience to law, the only means of prevention or cure.
I hold that the gouty, the rheumatic, the strumous, the “colds,” and all
other diatheses, are practically unimportant distinctions. The technical
difference is, of course, well understood and admitted. In any event, it
is certain that the course of living best suited to prevent one, is also
best adapted to prevent or remove all. For all practical purposes,
however, they may be classed together; and whoever desires, either for
themselves or their children, exemption from, or the alleviation of,
suffering, have only to adopt a pure mode of living in order to escape, or
emerge from, the _disease diathesis_.
* * * * *
NOTE.——The limits of this work forbid an extended consideration
of the influence of this or that occupation in promoting this
disease; nor is it, in my estimation, essential. The trades must
go on, regardless of their influence upon health. There must,
for example, be painters, plumbers, compositors, tin-workers,
etc., even though the absorption of lead does tend to produce
the gouty condition and, so, a predisposition to renal disease.
A sufficient degree of care in other directions would enable
this class to outlive the more favored ones who neglect the laws
of life.
See note 2 in Appendix, p. 276.