DEFINITION.- A morbid condition of the urine, symptomatic of renal disease, but not always consequent on it, and characterized by the presence of albumen. It is a symptom, not a disease.
ALBUMINURIA is not Bright’s Disease. It is always associated with it, but may exist prior to and independently of any renal disease. If neither blood nor pus be present in the urine, but if nevertheless it be coagulable in even a considerable degree, thereby indicating the presence of albumen, it does not follow that there is any structural change in the substance of the gland.
DIAGNOSIS.- Dr. Roberts has shown hot to determine whether Albuminuria be consequent on renal disease, ascertaining; (I) The temporary or persistent duration of the Albuminuria; (2) The quantity of the albumen present, and the occurrence and character of a deposit of renal derivatives; (3) the presence or absence of any disease outside the kidneys which will account for the Albuminuria. Though Albumen is not a constituent of healthy urine, it may exist in the urine of healthy persons, or of persons whose health is only slightly and temporarily disordered.
SYMPTOMS.- The quantity, density, and colour of the urine remaining at a healthy standard, the test by heat and nitric acid show intermittent coagulability.
CAUSES.- Febrile and inflammatory diseases; visceral diseases; Dyspepsia excessive albuminous diet, such as eggs; bathing in cold water. Dr. G. Johnson has shown that prolonged cold bathing may produce transient Albuminuria.
EPITOME OF TREATMENT.- Aconite (incipient); Ac.-Phosphorus, Helonias (from nervous irritation); Lycopodium, Terebintha (with urinary symptoms); Arsenicum, Apocynum (OEdema and Dropsy).
178.- Nephritis-Bright’s Disease.
DEFINITION.- Nephritis is inflammation of the kidneys, producing a morbid condition of the gland and its secretions.
BRIGHT’S DISEASE is a morbid condition of the kidneys; the term is generic, and includes several forms of acute and chronic disease of the kidney, usually associated with album in the urine, and frequently with Dropsy, and with various secondary symptoms.
I. ACUTE NEPHRITIS-ACUTE BRIGHT’S DISEASE.
SYMPTOMS.- Anasarca of the upper as well as the lower parts of the body-the hand and feet as well as the face being puffy and swollen; febrile symptoms-a dry, harsh, skin; quick, hard pulse; thirst; and often sickness, from sympathy of the stomach with the kidneys. The skin is tense, with the infiltration of serious fluid through the subcutaneous areolar tissue and may pit on pressure. There is frequent desire to pass water, which is scanty, highly-coloured or smoky-looking, albuminous and of high specific gravity. If the urine be examined by the microscope, blood corpuscles may be seen in it, and granular casts of the minute tubes of the kidneys, consisting of numerous spheroidal tubes of epithelium; the kidneys being in an active state of congestion, if not of inflammation. If the urine he tested by threat and nitric acid, it will deposit albumen. this condition has been called Desquamative Nephritis, owing to the rapid separation of epithelium which goes on.
As may be inferred from what has been stated, both a chemical and microscopical examination of the urine is necessary, and should be made frequently, to determine the progress or decline of the disease. Indeed, without the aid of the microscope, it is often quite impossible to detect the variety and stage of the disease.
The renal symptoms are sometimes complicated with effusion into the pleural or abdominal cavities.
CAUSES.- The effects of fever, especially Scarlet Fever, exposure to wet and cold, as a contributory cause only, the action of irritating drugs, alcohol, etc. Dr. G. Johnson found, by an analysis of 200 cases, that intoxicating drinks cause 29 per cent. of all cases, and 12 per cent. arises from Scarlet Fever. The digestive and secretory functions being impaired, the blood and nervous system become deteriorated, the balance in the circulation is lost, and the secretion of the kidneys is changed.
2. CHRONIC NEPHRITIS-CHRONIC BRIGHT’S DISEASE.
SYMPTOMS.- Debility, general impairment of the health, and pallor of the surface, coming on insidiously with pain in the loins, and frequent desire to pass water, particularly at night, the urinary secretion being at first increased in quantity. The patient’s face becomes pallid, pasty, and oedematous, so that his features are flattened, and there is loss of appetite, acid eructations, nausea, and frequent sickness, which nothing in his diet can account for. His urine is found to be of less specific gravity than natural, as shown by the depth to which the urinometer sinks below its surface; it is also albuminous and coagulable by heat and nitric acid. There is most albumen at the beginning of the disease, because the kidney are more congested; but it is of lower specific gravity at the end, when the uninometer may go down to 1. 004, and then the quantity of urine is very small. At first the urine may be of a very dark or smoky colour, from containing blood corpuscles; but afterwards it becomes paler. There are two principal varieties of Chronic Nephritis. The first is usually the sequel to an acute attack, the other begins insidiously. Dropsy is more marked in the first variety and the second (with the so-called granular gouty kidney) is characterized by degeneration of the arteries with increased pulse tension, and changes in the heart of a degenerative nature.
The disease progress slowly; but sooner or later there is Anaemia. OEdema of the feet and ankles is present, and, in advanced stages, there may be Ascites, of general Dropsy. But Dropsy is not invariably a very marked symptom of the disease, especially in the variety of Chronic Nephritis known as contracted or gouty kidney. It is sometimes scarcely observed, death arising from Uraemia, symptoms of which are Delirium, Convulsions, and Coma; and of Coma the patient dies. Uraemia is so called from the belief that it is due to accumulation in the blood of urea and other poisons, but this is probably a mistaken view. It is much more likely a result of persistent high arterial tension. Sometimes, from the poisoned state of the blood, inflammation of a serous membrane arises, especially Pericarditis or Endocarditis, setting up valvular disease of the heart and then the patient becomes extremely dropsical, and is carried off by Asphyxia, from a complication of heart and kidney disease.
CAUSES.- Chronic Nephritis often follows Acute Nephritis; sometimes it is a result of bad living, intemperance, constant exposure to wet; Gout. Workers in lead-painters and plumbers-are particularly liable to the disease. It is a constitutional disease; both kidneys are equally affected.
TREATMENT.- The morbid condition in the acute and chronic forms of this disorder is the same. In detail, therefore, the treatment must be strictly adapted to the peculiarities of individual cases. The results of the remedies and means employed must be tested at regular intervals by an examination of the urine. Patience is necessary; after carefully deciding as to the line of treatment, it must be steadily persevered in, as marked improvement can only be seen after considerable time.
EPITOME OF TREATMENT.- Aconite (Incipient stage, feverish symptoms); Terebintha, Cantharis, Chelidonium (acute stage); Arsenicum, Sulphur, Mercurius, Corr., Phyto., (chronic); Nux V., Kreosotum, Ac,-Nit. (Dyspepsia); Opi., Ferrum (uraemic symptoms); Nux vomica, Arsenicum, (from alcoholic drinks); Ac.-Phosphorus (from suppuration or other cachexia); Plumb., Colchicum (granular degeneration); Ac.-Phosphorus (amyloid degeneration); Phosphorus (fatty degeneration ); Apis., Apocynum, Asclep-Tuberculinum, Mercurius-Cor. (in pregnancy and Scarlet Fever); Ferrum, Sulphur (convalescence).
Schmidt says he has obtained the most brilliant result by an exclusive milk diet, when all other treatment had failed. An adult will sometimes take as much as a gallon in the twenty-four hours. It may be given cold or tepid, and from half a pint to a pint at time. A preponderance of vegetable food, which makes less demand upon the secretory function of the kidneys than nitrogenous products, is likely to facilitate the success of remedial measures, indeed, meat in any form, or fish, must be given with the greatest caution. It is desirable also to limit the amount of salt taken.
ACCESSORY MEANS.- In the acute disease, warm-baths, or vapour- baths, should be had recourse to early, to promote the functions of the skin, lessen the Dropsy, and to carry off from the blood deleterious matters, which may be retained in it by inaction of the kidneys. Vapour-baths are preferable to warm baths, because they can be used at a higher temperature. The action of the bath may be much prolonged, and the bath in consequence rendered more efficacious, in the following manner. The patient is enveloped to the neck in a sheet wrung out of warm water, and three or four dry blankets are closely folded over it. He should be afterwards quickly dried, and wrapped up in blankets. If there be much Anaemia, warm baths should be employed with discretion. Further, to favour the free action of the skin, warm clothing-flannel and woollen garments-should be added, and chills and draughts guarded against. In chronic or convalescent cases, a healthy residence is necessary, including a sandy or chalky soil, and mild, dry air, so that out-of-door exercise may be taken. Patients with symptoms of Bright’s disease should be encouraged to take abundance of open-air exercise as long as strength permits, chills and fatigue being guarded against. Bathing or cold sponging, and frictions with a sheet or bath-towel, tend to arrest the disease and i invigorate the health. A Continental residence is preferable in many cases. By such means, and the administration of appropriate remedies, patients suffering from chronic disease of the kidney may live for years, enjoying the pleasures and fulfilling the duties of life.
179.- Cystitis-Inflammation of the Bladder.
(a) ACUTE CYSTITIS is a disease of rare occurrence, except when arising from Gonorrhoea, wounds, Calculi, the introduction of instruments, or other mechanical causes. Occasionally cold or damp may conduce to it.
SYMPTOMS.- There is usually pain, sense of weight, tenderness on pressure, and extreme irritability in the region of the bladder, with rigors, and often alarming constitutional disturbance. The urine is ejected by a sort of spasmodic action as soon as it collects, with straining, and, generally, much suffering; and there may be discharge of mucus or pus, tinged with blood.
(b) CHRONIC CYSTITIS is more common; it may be the sequel to an acute attack; or it may be caused by Calculi, disease of the prostate gland, Stricture, etc.; often by infection after passing of a catheter. The decomposing urine then becomes a source of irritation to the mucous lining of the bladder; the urea is soon decomposed into carbonate of ammonia, and this salt is acrid and irritating, and the bladder in time acquires a condition which has been aptly compared to that of a badly-washed utensil. The symptoms are the same as described under the acute form, though to a modified extent; but while the pain is less, the discharge generally greater. The mucus is often very abundant, a pint or more being often passed in the day, and it becomes very tenacious on standing, so that when a vessel containing the urine of such a patient is emptied, an abundance of ropy mucus follows the urine in a mass.
Cystitis may thus be diagnosed from Inflammation of the kidneys; in the former the pain travels upwards, towards the loins; while in the latter the pain extends from the loins down to the bladder.
TREATMENT.- The treatment of Cystitis must be regulated by its causes and associations. When simple, and resulting from cold, Aconite in alternation with Cantharis; if from exposure to damp, Dulcamara; if there be much nervous irritability, Belladonna For the chronic form of the disease, Cantharis, Cann.-Sat., Apis., Eup.- Pur., Kali Hyd., Pulsatilla, and Chim., are the best remedies. The last remedy is likely to be specially valuable.
ACCESSORY MEASURES.- For the relief of pain, hot fomentations; and in acute cases, rest in the horizontal posture. The warm hip- bath; the abdominal compress; and mucilaginous drinks, favour recovery. Washing out the bladder is often useful; but only small quantities of tepid water-one to two ounces-should be introduced at a time; a little boric acid should be added to the water; as far as possible; too, the water should be introduced slowly.
A urinary calculus or stone, consists of solid urinary constituents held together by an organic basis or network of an albuminous nature possibly derived from cells shed as a result of catarrhal processes. Stones are frequently multiple and may attain a large size.
Certain individuals pass little gritty cayenne-pepper-like particles, popularly known as sand, or gravel. When these particles become aggregated they from a stone whose size may vary from that of a hemp-seed to that of a pigeon egg or larger.
Stone is more frequent in certain families, and it is much more common in some countries, particularly Hungary, India, and China, than in others. In this country it is most prevalent in Norfolk, and is met with chiefly in boys under ten, and in adults after middle life. It occurs with almost equal frequency in the two sexes.
A urinary calculus may originate in the kidney (renal calculus), and if of small size pass thence down the ureter into the bladder, and be voided from there with the urine during the act of micturition. Or a renal calculus may remain in the kidney until by constant accretion it attain a size too considerable to permit of its passage down the ureter. Again, a renal calculus may pass into the bladder and there by accretion reach considerable dimensions. Lastly, stones may originate in the bladder itself.
STONE IN THE KIDNEY.- In the absence of bacterial infection a stone may lie in the kidney for years without giving rise to symptoms-latent stone. It may be said that it is a rule the larger the stone, the fewer the symptoms. As a rule, however, the patient complaints of dull aching and weight in the loin, or of recurrent attacks of colic, or of blood in the urine (haematuria).
Renal colic is characterized by agonizing pain shooting from the loin to the bladder, testicle, or thigh; nausea and vomiting, shivering and collapse, with cold perspiration. There may be frequent desire to urinate with the passage of a little blood- stained urine. The muscles of the belly-wall on the affected side are more or less rigid. The colic may recur at intervals till the stone is passed, or after one or two attacks may disappear altogether, the stone settling down in the kidney. The patient may complain of a persistent boring pain or feeling of weight in the loin, excited or aggravated by exertion, jolting, local pressure, or errors of diet.
STONE IN THE BLADDER.- The great majority of calculi found in the bladder have descended from the kidney, and after entering the bladder have increased in size. The minority take origin in the bladder. Men suffer from stone in the bladder much more frequently than women. This comparative immunity of women depends partly on the fact that the female urethra permits small calculi which have passed down from the kidney to escape, and partly on their exemption from those forms of chronic cystitis attended with stagnation of urine which lead to the formation of secondary stone.
STONE IN BOYS.- Sometimes stone forms in the bladder of boys, the symptoms being frequent micturition, even to incontinence, severe pain in passing water, occasional sudden stoppage of the urine, with accession of pain at the end of the penis, sometimes discharge of blood, muco-pus in the urine, and constant pulling at the foreskin, which becomes elongated.
SYMPTOMS OF STONE IN THE BLADDER.- There are four leading symptoms that are very suggestive (1) Increased frequency of passing water, chiefly during the day, and when moving about, and less so that night when at rest. Riding on horseback, for example, greatly increase the frequency. (2) Pain in the glans penis during and immediately after micturition, and a continuous desire to pass water for a few minutes, until fresh urine trickles down and separates the stone from the lining of the neck of the bladder, which is a highly sensitive part. As soon as sufficient urine collects relief is experienced. Pain low down in the abdomen may be due to chronic inflammation of the bladder. Pain before urinating is generally caused by a sensitive or inflamed mucous membrane. (3) The urine may contain muco-pus. This is due to the accompanying cystitis. (4) Blood may be passed from the to time in slight quantities at the end of micturition.
All symptoms are aggravated by movement and, therefore, worse by day than night, and so long as the bladder is not inflamed, are relieved by rest in bed. There may be sudden cessation of micturition or actual retention of urine from impaction of the stone at the orifice of the bladder.
Sooner or latter the symptoms of cystitis are added to those of stone. The urine undergoes alkaline decomposition and the stone increases in size by the deposition of phosphates. The symptoms are no longer so markedly relieved by rest, and the patient suffers by night as well as by day. In the final stages the health is further undermined by the ascent of the inflammation to the kidneys.
FURTHER EVIDENCE.- The four symptoms above enumerated, occurring simultaneously, point to stone in the bladder. But if additional evidence be desired, there are the microscopical and chemical tests of the urine, involving the application of various chemical reagents, the X-rays, the sound, and the cystoscope. The latter is an instrument by means of which every portion of the bladder can be explored by the eye of the surgeon.
Calculi in the kidneys, ureters, and bladder are, moreover, often distinguishable by means of the X-rays.
TREATMENT OF THE DIATHESIS.- Patients having a predisposition to the formation of Stone, especially if they have passed Calculi with their urine, require medical treatment and careful supervision to correct the tendency; for although useless to remove a Stone of size, remedies and in the expulsion of sand or gravel, and also correct the tendency to such formations. Under our treatment many patients who formerly passed small Calculi have entirely ceased to do so.
First and foremost, all avoidable causes must be removed-high living, the use of alcoholic liquors, and insufficient exercise, on the one hand; and overwork, anxiety, and excesses of all kinds, on other. Dyspeptic symptoms should be met by such means as are pointed out in the Section on Dyspepsia; and any other concurrent disorders should be corrected. Removal to a locality where pure soft water can be procured is often alone curative.
MEDICINES.- Among those used, the following are probably the most successful- Ac.-Phosphorus, Nux V., Ac.-Oxal., Lycopodium, Cann., Berb O Gelsemium, Aconite, Cantharis, Nat.-Carb., Podoph., Mercurius, Ocim., Can. During an attack of renal colic Morphia will almost certainly be needed.
When a Stone becomes dislodged, and is passing from the kidney down the ureter towards the bladder, or from the bladder through the urethra, the pain is extreme; the membrane of the canals is liable to be lacerated, and Inflammation and suppuration may supervene; or Irritability, Spasms, or Incontinence may trouble the patient for a long time.
To prescribe for a patient with Stone in his bladder such remedies as Cann., Belladonna, Nux V., or Phosphorus-Ac., to remove the pain and frequently of micturition; Vichy water to correct the altered urine; or Hamamelis, or Vichy water to correct the altered urine; or Hamamelis, or Cantharis, to arrest the haemorrhage, is useless, except to afford temporary relief; it would be wasting precious time and throwing away the opportunity of cure which an operation offers.
All cases in which there is even room for a suspicion of Calculus should be at once placed under the care of a professional Homoeopath.
181.- Enlargement of the Prostate.
This vague but convenient term refers to an affection met with in men after middle life, of which the most prominent symptom is an irritability of the bladder and a progressive incapacity to empty it. The prostate gland undergoes a considerable increase in size, and by pressing on the neck of the bladder forms an obstruction to the outflow of urine from that organ, so that the latter cannot be completely emptied.
Enlargement of the prostate is compatible with vigorous health and an absence of symptoms for a period which may range from months to years. The earliest symptom is that the patient has to rise from bed to make water, especially during the early morning hours. He notices that the urine is slow in coming, that the stream is less forcible, and that urine escapes after he thinks the act completed; he is inclined to strain in passing water, although this hinders rather than helps the flow. The repeated straining may induce piles and prolapse of the anus.
At any time the enlarged prostate may become congested from alcoholic or sexual excess, or from exposure to cold, especially if the patient has allowed his bladder to become full, for example on a railway journey, and he then finds himself unable to pass water; in other words there is acute retention.
TREATMENT.- To improve the muscular tone of the bladder and to train it to empty itself, the patient should, after passing water in the normal way, wait a minute or two and then try again. This should be practised as frequently as possible till only a very small quantity can be squeezed out (Say half an ounce). When this point has been reached, twice or thrice daily may suffice. When the symptoms are entirely due to the mechanical obstruction at the neck of the bladder, and the health and vitality of the patient are unimpaired, a radical operation for removal of the prostate is indicated.