[KIDNEY AND BLADDER 157]
ACUTE BRIGHT'S DISEASE. (Acute Inflammation of the Kidneys. Acute
Nephritis).--This occurs chiefly in young people and among grown men.
Exciting causes are exposure to cold, wet, burns, extensive skin tears
(lesions), scarlet fever, diphtheria, typhoid fever, measles and acute
tuberculosis, poisons; and pregnancy is one cause when it occurs in women.
Symptoms.--After exposure or scarlet fever the onset may be sudden,
sometimes with chills or chilliness, variable fever, pain in the loins,
watery swelling of the face and extremities, then of other portions of the
body like the abdomen, then general dropsy. Sometimes there is nausea,
vomiting, headache, delirium, or very deep sleep. The urine is scanty,
dark colored, of increased "specific gravity" and contains albumin, cells
and casts. Anemia is marked. After some fever disease, the onset is
gradual with anemia, swelling of the eyelids, face and extremities; scanty
thickish urine containing casts, then headache, nausea, vomiting, little
or no fever, dry skin. In these cases there may be gradual recovery,
attack of uraemia, or they may end in chronic nephritis.
Diagnosis.--Examine the urine often in pregnancy, scarlet fever, etc., and
especially when watery swelling is noticed.
Recovery.--The result in your children when it comes with scarlet fever is
not so good. It may run into chronic nephritis. In adults when it is due
to exposure the rule is recovery.
Treatment.--The patient must be kept in bed until there is complete
recovery. He should be clothed in flannel.
Diet and Nursing.--This must be of milk, water or mineral water in large
quantities; milk or buttermilk should be the main article of food. You can
give gruels made of arrowroot or oatmeal, barley water, beef tea and
chicken broth. But it is better to stick strictly to milk. As the patient
gets better, bread and butter, lettuce, watercress, grapes, oranges, and
other fruits may be given. The return to a meat diet should be gradual.
The patient should drink freely of mineral waters, ordinary water or
lemonade, these keep the kidneys flushed and wash out the "debris" from
the tubes. One dram of cream of tartar in a pint of boiling water, add the
juice of half a lemon and a little sugar; this when taken cold is a
pleasant satisfactory diluting drink. Cream of tartar one dram, juice of
lemon, sugar sufficient, water one pint, may be given whenever desired.
There should be hot water baths daily or oftener; or you can produce
sweating by placing hot water jars around the patient, and watch to see
whether it is too weakening. It can also be done by introducing steam
underneath the bedding, that is then lifted a little, so that the steam
vapor can circulate about the patient. Be careful not to burn the patient
with the hot steam. This, of course, is done through a hose attached to a
steaming kettle. Also see treatment of dropsy under "scarlet fever."
Bowels, Attention to.--They should be moved every morning by a saline
(salt) cathartic, if necessary, especially if the dropsy continues. This
produces watery stool. Cream of tartar and epsom salts, equal parts, is
good remedy; one-half teaspoonful every three hours for a child one year
old until the bowels move freely; one-half to one ounce can be given to an
adult.
[158 MOTHERS' REMEDIES]
CHRONIC BRIGHT'S DISEASE. (Chronic Parenchymatous Nephritis. Chronic
Diffuse Desquamative or Tubal Nephritis. Chronic Diffuse Nephritis with
Exudation). Causes.--Young adult life and most common in males. It may
come from acute inflammation of the kidneys that was due to exposure,
pregnancy, or scarlet fever, or follow excessive use of alcohol, etc. In
children it usually follows acute inflammation of the kidneys or scarlet
fever.
Condition.--The kidneys may be enlarged, with thin capsule, white surface,
cortex thickened and yellowish, or whitish (large white kidney). The
epithelium of the tubules is granular, or fatty or the tubules are
distended and contain casts. Cells of the "Glomeruli" and their capsules
are swollen. There is moderate increase of interstitial tissue. In other
cases, the "small white kidney," the kidney is small and pale either at
first or as a later stage of the large white kidney. The surface is pale,
rough and granular; the capsule is thickened and partially adherent; the
surface is thin with white and yellowish areas of fatty degenerations. The
interstitial tissue is much increased; epithelial degeneration in the
tubules extensive. There is also the large red kidney, and with any of
these types the left heart may be enlarged and the arteries thickened.
Symptoms.--If it occurs after acute nephritis the symptoms of acute
nephritis subside, but anemia and the changes in the urine persist.
Usually there is a gradual onset with paleness and puffiness of the
eyelids, ankles or hands in the morning. Later there is difficult
breathing, increased watery swelling of the face, extremities and
dependent portions of the body; worse in the morning. There is a pasty
yellowish pallor, afterwards dropsy of the abdominal and chest cavities.
The urine is diminished, high colored, specific gravity usually 1020 to
1025 with much albumin. Many casts which are named hyaline, granular,
epithelial and fatty. The action of the heart is bad. There may be trouble
with the stomach and bowels, constipated, etc. The digestion is poor and
the patient frequently suffers with much gas. Recovery is rare after it
has lasted one year.
Treatment. Diet.--Milk or buttermilk should be the main article of food.
You can give gruels made of arrowroot or oatmeal, barley water, beef tea,
and chicken broth, but it is better to keep strictly to milk. As the
patient gets better, bread and butter, lettuce, watercress, grapes,
oranges and other fruits may be given. The return to the meat diet should
be gradual. The patient should drink freely of mineral water, ordinary
water, or lemonade. These keep the kidneys flushed and wash out the
"debris" from the tubes. One dram (teaspoonful) of cream of tartar in a
pint of boiling water, add the juice of a half a lemon and a little sugar.
This when taken cold is a pleasant, satisfactory drink. Medical treatment
is not satisfactory. The only thing to do is to give medicines to meet the
indications; fifteen to twenty grain doses of lactate of strontium.
Diuretin also is used. Basham's mixture for anemia is of help in some
cases. It can be bought at any drug store.
[KIDNEY AND BLADDER 159]
CHRONIC INTERSTITIAL NEPHRITIS. (Sclerosis or Cirrhosis of the Kidneys.
Granular, Contracted or Gouty Kidney).--This is met with, (a) as a
sequence of the large white kidneys forming the so-called pale granular or
secondary contracted kidney; (b) as an independent primary affection; as a
sequence of arterio-sclerosis.
Causes.--The primary form is chronic from the onset, and is a slow
creeping degeneration of the kidney substance, and in many respects an
anticipation of the gradual changes which take place in the organ in
extreme old age. Families in which the arteries tend to degenerate early
are more prone to this disease. Doctor Osler says: "Among the better
classes in this country Bright's disease is very common and is caused more
frequently by over-eating than by excesses in alcohol."
Arterio-Sclerotic Form.--This is the most common form in this country, and
is secondary to arterio-sclerosis. The kidneys are not much, if at all,
contracted; very hard, red and show patches of surface atrophy. It is seen
in men over forty who have worked hard, eaten freely, and taken alcohol to
excess. They are conspicuous victims of the "strenuous life," the
incessant tension of which is felt first in the arteries. After forty, in
men of this class, nothing is more salutary than to experience the shock
brought on by the knowledge of albumin and cast tubes in the urine.
Symptoms.--Perhaps a majority of the cases are latent (hidden) and are not
recognized until the occurrence of one of the serious and fatal
complications. There may have been no symptoms to suggest to the patient
the existence of a dangerous malady. In other cases the general health is
disturbed. The patient is tired, sleepless; he must get up two or three
times at night to pass urine; the digestion is disordered, the tongue is
coated; the patient complains of a headache, failing sight, and gets out
of breath by exercising. There may be vomiting, headache, neuralgia, and
increase of the quantity of urine is common. This is light in color, of
low specific gravity, 1005 to 1012; frequently there is a trace of albumin
and a few casts of the hyaline and granular kind. In the late stages the
albumin may be increased with high specific gravity and a less quantity of
urine. The disease often lasts for a year.
In the arterio-sclerotic variety the urine may be normal or diminished in
quantity, specific gravity normal or increased, the casts are more
numerous, and the albumin is usually more abundant. There is an
enlargement of the heart; the pulse is increased in tension; the wall of
the artery is thickened. The skin is usually dry, with eczema common, but
dropsy is rare, except when it is due to heart failure. There may be
bronchial and lung troubles; attacks of uraemia, or hard breathing caused
by the heart, frequently occurs. There may be hemorrhage of the brain or
hemorrhage of the membranes, and these are often fatal.
[160 MOTHERS' REMEDIES]
Recovery.--Chances are unfavorable, but life may be prolonged for years,
especially with care and especially if it is discovered early.
Treatment.--A quiet life without mental worry, with gentle but not
excessive exercise, and residence in a climate that is not changeable
should be recommended. A business man must give up his worry; his rush;
his hurried eating, and rest. The bowels should be kept regular; there
should be a tepid water bath daily, and the kidneys should be kept acting
freely by drinking daily a definite amount of either distilled water or
some pleasant mineral water. Alcohol, tobacco, excessive eating and
improper food must not be allowed. Weak tea and coffee may be allowed. The
diet should be light and nourishing. Meat should not be taken more than
once a day. If it is possible, the patient should be urged to move to a
warm equable climate during the winter months, from November to April,
like that of southern California. Medicines must be given to meet the
indications. No special directions can be given. The heart, stomach, and
bowels must be watched.