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a hot poultice or hot cloths applied over the lower part of the belly, may afford relief. Injections of hot water into the bowel are often more efficient still. A single full dose of opium in some form, as fifteen drops of laudanum1 or two teaspoonfuls of paregoric1 or onequarter grain of morphine,1 will frequently allow of a free passage of urine. The introduction of a suppository into the bowel, containing one-quarter grain each of morphine sulphate, and belladonna extract, is often preferable to giving the drug by the mouth. These measures proving of no avail, the next endeavor should be to pass a catheter. If a soft rubber or elastic catheter is used with reasonable care, little damage can be done, even by a novice. The catheter should be boiled in water for ten minutes, and after washing his hands thoroughly the attendant should anoint the catheter with sweet oil (which has been boiled) or clean vaseline and proceed to introduce the catheter slowly into the urinary passage until the urine begins to flow out through the instrument.
A medium-sized catheter is most generally suitable, as a No. 16 of the French scale, or a No. 8 of the English scale.
BRIGHT'S DISEASE OF THE KIDNEYS.Bright's disease of the kidneys is acute or chronic, and its presence can be definitely determined only by chemical and microscopical examination of the urine. Acute Bright's disease coming on in persons previ
1Caution. Dangerous. Use only on physician's order.
ously well may often, however, present certain symptoms by which its existence may be suspected even by the layman.
ACUTE BRIGHT'S DISEASE; ACUTE INFLAMMATION OF THE KIDNEYS. Acute Bright's disease is often the result of exposure to cold and wet. Inflammation of the kidneys may be produced by swallowing turpentine, many of the cheap flavoring extracts in large amounts, carbolic acid, and Spanish flies; the external use of large quantities of turpentine, carbolic acid, or Spanish flies may also lead to acute inflammation of the kidneys. It occurs occasionally in pregnant women. The contagious germ diseases are very frequently the source of acute Bright's disease either as a complication or sequel. Thus scarlet fever is the most frequent cause, but measles, smallpox, chickenpox, yellow fever, typhoid fever, erysipelas, diphtheria, cholera, and malaria are also causative factors.
Symptoms.-Acute Bright's disease may develop suddenly with pallor and puffiness of the face owing to dropsy. The eyelids, ankles, legs, and lower part of the belly are apt to show the dropsy most. There may be nausea, vomiting, pain and lameness in the small part of the back, chills and fever, loss of appetite, and often constipation. In children convulsions sometimes appear. The urine is small in amount, perhaps not more than a cupful in twenty-four hours, instead of the normal daily excretion of three pints. Occasionally
complete suppression of urine occurs. It is high-colored, either smoky or of a porter color, or sometimes a dark or even bright red, from the pressure of blood. Stupor and unconsciousness may supervene in severe cases. Recovery usually occurs, in favorable cases, within a few weeks, with gradually diminishing dropsy and increasing secretion of urine, or the disease may end in a chronic disorder of the kidneys. If acute Bright's disease is caused by, or complicated with, other diseases, the probable result becomes much more difficult to predict.
Treatment. The failure of the kidneys to perform their usual function of eliminating waste matter from the blood makes it necessary for the skin and bowels to do double duty. The patient should remain in bed and be kept very warm with flannel night clothes and blankets next the body. The diet should consist wholly of milk, a glass every two hours, in those with whom it agrees, and in others gruels may be substituted to some extent. The addition to milk of mineral waters, limewater, small amounts of tea, coffee, or salt often makes it more palatable to those otherwise disliking it. As the patient improves, bread and butter, green and juicy vegetables, and fruits may be permitted. An abundance of pure water is always desirable. The bowels should be kept loose from the outset by salts given in as little water as possible and immediately followed by a glass of pure water. A teaspoonful may be given hourly till the bowels move.
Epsom or Glauber's salts are efficient, but the compound jalap powder is the best purgative. Children, or those to whom these remedies are repugnant, may take the solution of citrate of magnesia, of which the dose is one-half to a whole bottle for adults. The skin is stimulated by the patient's lying in a hot bath for twenty minutes each day or, if this is not possible, by wrapping the patient in a blanket wrung out of hot water and covered by a dry blanket, and then by a rubber or waterproof sheet, and he is allowed to remain in it for an hour with a cold cloth to the head. If the patient takes the hot bath he should be immediately wrapped in warmed blankets on leaving it, and receive a hot drink of lemonade to stimulate sweating. For treatment of convulsions, see Vol. I, p. 188. Vomiting is allayed by swallowing cracked ice, single doses of bismuth subnitrate (one-quarter teaspoonful) once in three hours, and by heat applied externally over the stomach. Recovery is hastened by avoiding cold and damp, and persisting with a liquid diet for a considerable period. A course of iron is usually desirable after a few weeks have elapsed to improve the quality of the blood; ten drops of the tincture of the chloride of iron taken in water through a glass tube by adults; for children five to ten drops of the syrup of the iodide of iron. In either case the medicine should be taken three times daily after meals.
CHRONIC BRIGHT'S DISEASE.-This includes several forms of kidney disease. The symptoms
are often very obscure, and the condition may not be discovered or suspected by the physician until an examination of the urine is made, which should always be done in any case of serious or obscure disorder. Accidental discovery of Bright's disease during examination for life insurance is not rare. The disease may exist for years without serious impairment resulting.
Causes. Chronic Bright's disease often follows and is the result of fevers and acute inflammation of the kidneys. It is more common in adults. Overeating, more especially of meat, and overdrinking of alcohol are frequent causes. Gout is a frequent factor in its causation. The disease has in the past been regarded as a local disease of the kidneys, but recent research makes it probable that there is a general disorder of the system due to some faulty assimilation of food-especially when the diet itself is faulty-with the production of chemical products which damage various organs in the body as well as the kidneys, notably the heart and blood vessels.
Symptoms. The symptoms are most diverse and varied and it is not possible to be sure of the existence of the disease without a careful physical examination, together with a complete examination of the urine, both made by a competent physician. Patients may be afflicted with the disease for long periods without any symptoms until some sudden complication calls attention to the underlying trouble. Symptoms sug