Cantharides is suitable in the treatment of Bright’s disease at all times when the urine, containing albumin and blood in abundance, is passed in small quantity, together with tenesmus. We should administer it after the beginning, when there is no fever, or when Belladonna has reduced the temperature. Cantharides acts very promptly. Its first effect is to cause blood to disappear from the urine and to increase the quantity of urine considerably. It is not unusual to see the urine reach 2, 3 and 4 litres from the first days of the administration of Cantharides.
Dose and Method of Administration: We seldom prescribe the tincture, and then never more than three drops a day of it. We have been most rapidly successful by the use of the first dilutions, administered as in the case of belladonna.
3. Apium Virus.-The position of the honey-bee, in its action upon acute nephritis, has great analogy to that of Cantharides, but it is more particularly indicated when there is considerable anasarca. In my clinical lessons of 1892 may be found observations on a case of acute Bright’s disease, very rapidly helped by the poison of the honey-bee, with a diuresis which exceeded three litres a day. Apium virus lacks at present sufficiently extensive clinical confirmation, but we know enough about this remedy not to hesitate to prescribe it when the indications are present which I have mentioned.
4. Koch’s Lymph.-Clinical observations and experiments upon animals have shown that injection of Koch’s lymph produce parenchymatous nephritis together with Albuminous urine. I am not aware of the sings which allow us to determine the indications for the use of this remedy in the acute stage of Bright’s disease; therefore I have almost always reserved its use for the chronic period of this disease, and also for the treatment of interstitial nephritis. We know that in these two cases the lesions of the kidney are established, and that, in consequence, we cannot hope for a radical cure. Whenever we have prescribed Koch’s lymph in such cases, we have obtained an amelioration characterized by considerable diminution of albumin and by amelioration of the general health.
Dose and method of Administration: We have never made hypodermic injections in the treatment of the nephritis. We have confined ourselves to prescribing Koch’s lymph in the sixth or third dilution; three doses a day for six days. Cease giving the remedy from one to four days following the effect obtained, then begin again.
5. Iodium.-This is a remedy which we shall find suitable to the treatment of interstitial nephritis, but it has also given very good results in the treatment of Bright’s disease, which is still acute. The dose in this case has been one of the first triturations of the Iodide of sodium. The other remedies indicated in the treatment of chronic Bright’s disease, or in interstitial nephritis, are Lead, Arsenic, Phosphorus, Mercury, Nitric acid, etc.
If we should wish to enumerate all the drugs which may produce interstitial nephritis, with passage of albumin into the urine, the list would be long; but I do not believe that the physician would derive great benefit from use of them.
Phosphorus, and especially Phosphoric acid, produced the majority of the symptoms of interstitial nephritis. But have they ever cured a single case of this affection?.
As to Plumbum, no drug presents a more complete image, not only of interracial nephritis, but even of general arterio- sclerosis, and yet I have never obtained results from the use of this drug. Possibly I have not administered the preparation in suitable dose. Plumbum should always be studied in connection with the treatment of chronic inflammations of the kidney.
Dose and Method of Administration: We use almost always the three first triturations of the Iodide of sodium. Administered, as we have said, in the case of Apium virus. In rebellious cases, we have found it well to administer several centigrammes (a centigrammes equals about one-sixth of a grain) of the crude drug.
We have not mentioned Fuchsine, nor Methyl blue, nor so many other substances, heralded as panaceas in Bright’s disease, which have been forgotten as soon as discovered.
Treatment of Uraemic Accidents.-Sometimes we do not hesitate to prescribe copious bleeding when eclampsia or uraemic coma shows itself in strong patients, and in those who are still in the acute period of the disease.
Moreover, this practice had, and still has, its very earnest advocates for uraemic accidents which show themselves pregnancy. We do not absolutely condemn its use, not understanding entirely its mode of action, we never employ it.
Chloroform, Belladonna, and its succedaneum, Opium, and, lastly, in certain cases, purgatives, indications for which we shall try to determine, constitute the means which we habitually use in the treatment of uraemic accidents.
1. Chloroform.-Chloroform is an heroic remedy for attacks of eclampsia, to which it is, moreover, absolutely Homoeopathic. It is universally accepted by physicians and accoucheurs.
Does and Method of Administration: The most energetic method of administering Chloroform consists in giving inhalations so as to produce anaesthesia. Suspend administration of the drug when convulsions have ceased, beginning again when they commence in turn. In practice, Chloroform is often replaced by Chloral, because the presence of a physician is not required for the administration of this latter remedy. It is more convenient to administer it in enemata, in doses of 4 grammes (about 62 grains), in the case of adults. The action of Chloral is slower and also more prolonged than that of Chloroform. Its administration may be renewed whenever the anaesthetic sleep ceases and convulsion begin again.
2. Belladonna, Aethusa Cynapium.-These were our two principal remedies before the discovery of Chloroform.
Belladonna and AEthusa are indicated in the eclamptic form of Uraemia. Moreover, Belladonna is still indicated during uraemic coma, when the pupil is dilated, the face pale, and the pulse frequent. In the cases in which delirium comes on, then again we must have recourse to Belladonna.
Dose and method of Administration: The three first decimal dilutions, one drop every quarter of an hour, in cases of eclampsia; in other cases, one drop every two hours.
3. Opium.-This drug is indicated in uraemic coma, with contracted pupils, red face, pulse full and slow. it is also indicated in uraemic dyspnoea.
Dose and Method of Administration: I prescribe usually the first triturations, twenty centigrammes (about three grains) in a hundred grammes (about three fluid ounces) of water. A teaspoonful every two or three hours. In cases in which patients cannot swallow, or swallow with difficulty, I have found it well to inject, by the hypodermic method, Tincture of opium, one in one hundred; that is to say, the first dilution, this dilution being made in distilled water.
In uraemic dyspnoea it is preferable to inject eight or ten drops of a solution of Morphine, one in one hundred, this drug being absolutely Homoeopathic to dyspnoea. Injections may be renewed every two or four hours.
Jaborandi and its alkaloid, Pilocarpine, and also transfusion of blood, have been lauded, but these are agents which are essentially dangerous.
4. Drastic Purgatives.-Although treatment by drastic purgatives has nothing Homoeopathic about it, and although it is solely a question of their physiological action, which is to withdraw a great quantity of water from the system, we should, nevertheless, not reject them entirely,and in desperate cases, in which standard remedies have been without effect, purgation may lead to a considerable amelioration, especially when uraemic accidents ar characterized by coma and very general anasarca.
As a rule, use of purgatives has only a palliative effect, and the amelioration it produces has but slight duration.
Method of Administration: We use usually German brandy, forty grammes (a little over a fluid ounce) sweetened with twenty grammes (a little less than a fluid ounce) of syrup of Nerprun (Buckthorn).
Diet and Hygienic Precautions in Bright’s Disease.-Absolute milk diet is perfection in acute Bright’s disease, and also during the outbreaks which come on in the course of the disease, when the nephritis has passed into the chronic state. The patient should take three or four litres (about three or four quarts) of milk a day, in small doses repeated every two hours; the milk may be boiled or not, salted, sweetened or natural.
It is carrying matters to a dangerous extreme to prescribe an absolute milk diet for patients in all stages and in all forms Bright’s disease.
When the patient is better-when his health has, at least, apparently returned-we should advise the mixed milk diet, which consists in the administration of one or two litres of milk diluted in part in the form of soup. We may allow at the same time poultry, ham, fish, and also, a little later, mutton and beef. Eggs may also be allowed albuminuric patients,except during the acute period.
