MADAME PRESIDENT and fellow-practitioners: My line of thought for some time past has been turned rather persistently in the direction of albuminuria. At the present time medical opinion appears to me to be in somewhat of a transition stage in regard to the pathology of diseases of the genito-urinary organs. A good many ancient (and Allopathic) fallacies have been exposed and dropped, and we, the Homoeopathists, are building up newer views upon surer foundations. The process will be show (it is hardly more than begun), for the problems to be solved are so very numerous. I have endeavored to look at the subject of my paper in the light of present knowledge only, and not to go on step beyond what that state of knowledge would seem to justify.
I have kept rigidly before my mind, too, the fact that childhood only, at the present time, is my sphere and, as a consequence, I can only touch upon such point in the general pathology of albuminuria as are within the limits of this restriction. Albuminuria, we know, may be produced in children from a variety of causes; the rarest causation, however, is, I think, due to pressure on the renal veins; but let the causative agent be what it may, I believe albuminuria should always be viewed with gravity.
If I might occupy a few moments of time with a hasty review of the physiology of the kidneys, I should be glad, as I think it will freshen our memories and assist us in the discussion of this subject-a subject I am most anxious to have discussed both bore and now; for I am assured that a finer opportunity for eliciting important truths from a conflict of fine minds will never arise.
Physiology of the Kidneys: Gaze with a retrospective eye, if you please, and we find that the membranous covering of the internal surface of the secretory cells of the kidney is really a true protective organ, keeping from the protoplasm of the cells any substances likely to interfere with their functions. We remember, too, that this membrane varies in its structure, and the variation is due to the degree of functional activity of the epithelium.
In conditions of repose this membrane is homogenous; in conditions of activity it is peculiarly marked, having a quantity of clear streaks running through it, and taking on the appearance of a structure formed of small straight rods, these being held together or separated by an intermediate substance of a clear fluid character. After some great functional excitation a remarkable change takes place; the collected urine detaches and pushes away this membrane from the protoplasm.
The products of the renal secretion collect within the epithelial cells in the form of liquid masses, having either a rounded or elongated appearance, and clear, like the contents of the tubules. This fluid percolates through openings in the limiting membrane, sometimes, breaking through the latter to gain the interior of the canaliculi, often detaching and carrying it away.
A great advance has been made in our study of aetiology, proven by the fact of our knowing that a micro-organismal factor exerts its most prominent pathological influence upon the kidneys.
Within the past year or two some notable contributions have been made to the literature of this disease, notably, that of Clifford Mitchell, whose able exposition of the relation of urinary analysis to diet is of untold value; of Mannaberg, upon the relation of acute nephritis and the streptococci found in endocarditis. In eleven cases of acute nephritis, Mannaberg found the urine to contain streptococci, which disappeared from the exertion with the disappearance of the symptoms of disease.
In patients affected by other maladies, and in healthy individuals, this micro-organism is not to be found, although searched for in a long series of urines. Mannaberg has cultivated this streptococcus in question and separated it, by peculiarities in its cultivation, from other varieties of streptococci. These do not appear to select the kidneys as an especial position for growth; they probably multiply in the blood and tissues generally; and in their escape through the renal structures, produce their series consequences.
This, undoubtedly, is a form of blood-poisoning specially involving the kidneys. As I before said, a great many old fallacies have been dropped; the trend of thought and study to-day is carrying us still further and further from the old lines of thought; views formerly held are either passing into desuetude or becoming very much restricted; causes of disease, formerly hardly conjectured, are being added to the list, and some factors of causation, such as exposure to dampness, cold, etc., are dropped out.
I might occupy your time by citing almost numberless cases, published both abroad and at home by adherents of both schools,,where there is no apparent causation of renal disease from exposure to dampness or cold. I will merely cite from Letzerich. He observed a number of cases of renal inflammation, due to characteristic bacillus, from cultures of which he could reproduce nephritis in rabbits. The symptoms he found in general similar to those in other cases of nephritis, somewhat mild in form, but showing a predominance of gastric phenomena.
He found the spleen apt to be swollen, with considerable fever, and often rapidly developing oedema and effusion into the serous cavities. The urine contained short, straight or curved rods, in large numbers. These symptoms, finding no history of exposure to dampness or cold, make the suggestion of a micro- organism exceedingly relevant, especially so, when taking into consideration the manner of onset, the involvement of the lungs, and the prostration accompanying the affection. The affection in question was found most commonly in children, and in cases which came to post-mortem section, it was found that the bacilli developed only in the interstitial structure of the kidney; the spores were, however, found generally throughout the body.
At no previous time has the question of the infections nature of the renal affection, known as Bright’s disease, been so forcibly placed before the profession; and there can be no doubt whatever as to the prominence which will hereafter be accorded to infections influences in the production of the malady. An exceedingly interesting and instructive paper, published by Agnes Bluhm, upon the aetiology of Bright’s disease, is based upon an analysis of 8442 cases, material derived from clinics during a period of five or six years; and the vast majority of these cases were clearly traced to an infections origin.
We find to-day a good many men in our own school, besides numbers of outsiders, who still pin their faith to a belief in the constant existence of albumin in normal urine. After having made a great number of carefully conducted examination of normal urine, I feel compelled to place in opposition to these. The result of my experiments have proven most satisfactorily to my own mind that the presence of albumin is not characteristic of normal urine. There are some of us who argue, that small amounts occurring in normal urine tentatively is of no significance; that it is only where it reaches any proportion that it should be seriously considered.
I believe that the smallest possible amount should be viewed with gravity, and that under any circumstances whatever, albuminuria means some fault of the epithelial covering of the glomerules. Probably Purdy’s experience along these lines has been as large as any one man’s. He, in a publication of his upon examination of urine for life-insurance, takes this position: “No applicant for life-insurance should be debarred on account of albuminuria, but the time has arrived fro stamping out the idea so prevalent among the profession, that the slighter traces of albumin in the urine are of no significance.
It has been my experience during the past five years to make a large number of analyses of urine, from cases of al sorts, but never once have I met with a single case of albuminuria in which a microscopical examinations have not always returned me the foregoing result, but repeated searching has never failed to disclose pathological evidence, so I have arrived at this conclusion: there is positively no such thing as a physiological albuminuria”.
Physiological albuminuria, however, is a term which has fund so much favor with the profession generally, that whatever the belief may be, it-the term-will, in al probability, remain in vague. I believe that albuminuria is many times the product of an incomplete or pernicious digestion. The incomplete transformation of the albumin leads to the production of a relative albuminuria, and from this, by very evident steps, to a true albuminuria. So, too, the various toxic substances, from a perverted digestion, are brought to the kidneys, in their excretion producing a like train of events.
I think, when we are testing for albumin, we should select the specimen of urine voided at the time when the patient is most fatigued; the amount of albumin, as we know, is greatly influenced by circumstances. Then should begin an exhaustive examination for casts, and if one fail to find them when they are actually present, the result must be a serious error in diagnosis.
Since I have insisted upon the entire collection of urine voided within the twenty-four hours, my experiments have proved much more satisfactory to myself and beneficial to my patients. When searching for albumin, I have the child exercise as vigorously its is prudent before voiding urine for examination, and where the case is doubtful, I examine the urine of each micturition during the entire twenty-four hours. I need hardly say that the commonest cause of albuminuria is Bright’s disease, but I do consider it my duty to say that I believe a large proportion of the so-called “physiological or functional albuminurias” eventuate in this malady unless treated before being allowed to endure for any length of time.
We are to-day familiar with the fact that nephritis is a disease common to childhood, arising most frequently after scarletina or other blood poison. Formerly it was considered as one of the results of cold, dampness and drinking habits-its especial province the adult.
The average of disease in childhood is acute, so the prognosis for nephritis as regards complete recovery is mostly good. As a mere matter of enumeration we are perfectly familiar with the symptoms of acute Bright’s disease-the pallor, the vomiting, convulsions, urine, with a large percentage of albumin; but individual cases are of most interest just now. However B., a boy aged ten, was placed under my care. His previous history was god, except for an attack of typhoid fever some nine months previous. The boy was hardly to be called sick (from the time of his recovery from the fever until placed under my care), at least for the greater part of the time.
Ailing at times for two or three days together, causing great anxiety then, and again appearing to be, and insisting upon the fact of his being, perfectly well. There had been an occasional slight swelling of the lower limbs-a fact to which the mother attached no importance. When I first saw him he was in bed, and the swelling had been on the gradual increase. I found the lad in a condition of extensive anasarca, the action of the heart very irregular. The urine was only a few ounces in twenty-four hours; sp. gr. 1024; full of albumin and containing granular and hyaline casts.
The boy during all this time, a period of nine months of treatment, insisted that he was well. The sp.gr. of the urine rose as high as 1030, and for a period of eight months the albumin averaged throughout from a third to a sixth. From that time on it decreased from one-fifth to one-twenty-fifth, and during the last five or six days it disappeared entirely. I began treatment by restricting his diet-much to the boy’s chagrin- keeping him to milk and water, jelly, bread and butter, sweet potatoes and peptonized milk toast. Digitalis and, later on, Ferrum continually, brought the boy around. Since that time be has remained well.
A somewhat interesting case of incontinence of the urine came under my care recently-the patient a girl six years of age. The previous history, according to the mother’s statement, was one of perfect health. Application was made for admission to the public schools. The child could not gain admission until vaccinated. From that time on she was ailing, the entire body breaking out in sores. There was a discharge from the right ear, and back of the car a superficial abscess. The urine at the time was dark, contained coloring-matter and was loaded with albumin. The child was suffering at the same time from prolapsus uteri, with leucorrhoea. I need hardly speak here of the two avenues for physical examination.
There is but one way to treat such cases as the forgoing: by means of combined rectal and abdominal palpation. In the case of the child just mentioned the belly walls were both fat and relaxed, and there seemed a great possibility of considerable resistance being offered. It was important that the examination should be through, therefore I anaesthetized at once. Indeed, I think it advisable in all such cases; the effects are rapid, the duration short and the resistance slight. The rectal touch is the most certain way of approaching tubes and ovaries to be questioned, and combined with palpation by the other hand on the abdomen, is greatly enhanced in value. Rectal and bimanual massage proved very effective in restoring the pelvic organs to their normal tone.
This accomplished, the albumin, which heretofore had appeared with the greatest regularity, disappeared. No casts were discoverable; so the altered condition of the urine I considered as due to the altered conditions of pressure in the pelvic and renal circulations. The muscular tone of the patient was influenced considerably by daily applications of electricity. China proved very useful here. I had a favorable and uninterrupted action of the single prescription and minimum dose of the single indicated remedy. This Hahnemannic trio, I rejoice to say, speaks for itself without any trumpeting.
We have been accused by the Old-School men of “Never having discovered a single bacillus.” Shall we ever rally from the thrust or dare to look a brother Allopath in the face again after being told such a thing as this? And yet who is specially benefited by knowing that a certain comma bacillus is found in this or a rod-shaped one in another? We have a law, that a particular medicine produces a definite result, and that one thing we have proven to be of more practical use than the natural history of all diseases combined could ever be.
In cases of incontinence of the urine treatment must be given with an eye to the cause, the principal causes being the various motor neuroses. A large number of such cases are exceedingly troublesome; when, however, there is irritability of the bladder, I believe Belladonna will prove your friend in almost every instance. In such cases I believe we cannot lay too much stress upon message of the bladder per rectum. It has given me most excellent results, together with a daily salt-water bath, accompanied by brisk rubbing in the region of the spine; there must, too, in such cases, be a careful consideration given to hygiene and diet, and last, but by no means least, attend to the psychical surroundings.
This may, on first thought, appear overstrained and far- fetched; I make it a strong point simply because I have watched the effects on a nervous child of a nurse thoroughly uncongenial. I have seen the same kind of thing obtain in the hospital, where children were away from home, everything strange and new. It must be unnecessary for me to say that “powerful emotions” bring an increase of albumin in the urine. And, believe me, you will experience unexpected results frequently, if you turn your attention wit vigor toward this one thing.
I think, if I remember rightly, our own Dr. Clifford Mitchell lays considerable stress upon this; to my mind, it is something to be strongly considered, whatever the malady my be. I was asked, in preparing this paper, to show the prophylactic properties of Homoeopathy in relation to my subject. I confess myself almost totally at a loss here. The causes of “Albuminuria in Children” are many, are unforeseen, and it appears to me quite impossible to treat of it prophylactically. In concluding this hastily written and very imperfect paper, I should like to say a few words to our confreres from abroad.
An Englishman, some time since, said, in a way that was quite characteristic of the national generosity and kindliness of spirit, “It is the American Homoeopathists we own it-to their indomitable independence, energy and pluck-that Homoeopathy stands in the position it does to-day in the United States and before the world; aided by the free institutions of their country and the emancipated minds of the people, they have been able to achieve what we have scarcely attempted.” The gentleman who wrote those words may be here to-day; if he is, I should esteem it a pleasure and privilege to meet him.
That the onward sweep of Homoeopathy in this, our own land, has been overwhelmingly irresistible is a fact far and away beyond dispute. We owe its success, in a large measure, to the attitude taken by the Homoeopathic pioneers. If only you Englishmen would acquire or wrest the right to teach, and grant diplomas to your won students, headway would be made immediately. Why should you beg recognition from Allopathic colleges for a fact which the entire would at large accepts?
If any one thing more than another would stand as proof of the progress of scientific medicine, it is the fact that the men of the Old-School are rapidly incorporating into their materia medica our laws of cure; by giving medicines both palatable to the sense of taste and pleasant to the sense of sight, they are so thoroughly revolutionizing their style of practice that, except for the old empirical tendencies still clinging to them, we should almost fail in recognizing them. The time has arrived, I think, for sweeping some of these pirates from their medical high seats; it is being done rapidly here. In the name of these assembled Homoeopathists, let me beg of you to gird up your loins, buckle on your armor, and fight the good fight, doing for Homoeopathic in England what we have done for it in America-place it to the fore.