177.- Albuminuria.
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.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."