CHRONIC BRIGHT'S DISEASE.
The hematuria of granular kidney is, I believe, best treated by absolute rest in bed, and a strict diet of milk. If the hemorrhage is not excessive, and the patient is able to get about, Turkish baths (without massage and the cold douche) may be taken with benefit and the bleeding often abruptly ceases in consequence, the free action of the skin reducing the congestion of the kidney. But if the hemor rhage has proved obstinate or profuse, it is better that the patient should keep to the bed, a hot-air bath being administered by means of a cradle and a spirit-lamp.
The most convenient form is that in which the air is heated in a receiver by means of a spirit-lamp, and is conveyed under the bed clothes, which are supported over the patient by means of an iron cradle. The following mixture may be given simultaneously with benefit: All stimulating diuretics, such as juniper, turpentine, cantharides, copaiba, santal, or cubebs, should be avoided. The bowels had better be acted upon very gently, preferably by means of rectal enemata of soap and water or glycerin.
The renal hematuria in syphilitics may be combated by ordinary antisyphilitic treatment, a valuable addition to the mixture being the compound decoction of sarsaparilla and the extract of hamamelis virginica.
The hematuria occurring in cardiac disease and in the acute ne phritis grafted on chronic Bright's disease, must be treated on the usual principles laid down for these diseases.
Stone in the Kidney.
The appropriate treatment for hematuria caused by calculous disease of the kidney must be varied slightly according to the charac ter of the urinary deposit. If the microscope or the eye detect a uratic condition of urine without pus, then moderate rest, a spare diet, avoidance of all alcohol, and the free use of alkaline waters, such as Coutrexeville, Kronenquelle, or Wildungen, will usually suffice to check any tendency to hematuria. The bowels had better be regulated by
a dose of phosphate of sodium (two teaspoonfuls) well diluted with water each morning. If the alkaline waters cannot be obtained, a teaspoonful of effervescing citrate of potash in half a tumblerful of water may be taken, or a very useful sherbet can be made thus: Keep in a glass-stoppered bottle. A teaspoonful to be taken in a tumblerful of water twice a day.
Boracite of magnesia is advocated by Dr. Koehler of Posen (Berliner klinische Wochemehrift, Nov. 3d, 1870) for cases of uric-acid calculi and gravel. It is prepared by dissolving a natural borate of magnesia, which is found at Stassfurt, in citric acid. It may be taken twice or thrice daily in teaspoonful doses dissolved in a tum blerful of warm water.
Hemorrhage in oxaluria and oxalate of lime calculus is perhaps more difficult to arrest. No brusque movements should be allowed; the diet must be stricter, and free from sugar in any form; all un cooked fruits ought to be avoided. Usually the acids in some bitter infusion succeed best. The following is valuable: Hemorrhage, when due to phosphatic calculi, the urine being usually alkaline, often abates on the exhibition of the citro-borate of magnesia, or after a combination of boric acid and benzoate of soda with infusion of chiretta or serpentary. If there is pus also present in the urine the balsamic drugs are of value when taken in capsule at night after supper: turpentine, five drops; copaiba oil, ten drops; santal oil, ten drops cautiously increased. The diet must be liberal and varied, and some form of stimulant should be added. Skilled nephrolithatomy, if no suppuration has taken place, is free from risk.