THE SYMPTOMS which it is customary to call urmic are : 1. Headache and sleeplessness, which come on in attacks of short duration, or may be continued for many weeks. The headache may be of mild type, or very severe. In extreme cases the pain is so se vere and the sleeplessness so distressing that the patients are almost maniacal. These symptoms may accompany : (a) Puerperal Eclampsia either with or without Nephritis. At the time of the attack the urine is diminished in quantity but of good specific gravity. The arteries are full and tense, the heart's action is exaggerated, the veins are congested. The headache can be relieved by the birth of the child, by general blood-letting, by morphine, and by the drugs which dilate the arteries.
(b) Acute Exudative and Acute Productive Nephritis. At the time of the attack the urine is often, but not always, diminished; its specific gravity is good. The arteries are full and tense, the heart's VaL. I.
action is exaggerated. The headache can be relieved by the arterial dilators, by morphine, by purging, by sweating. General blood-let ting can but seldom be used.
(c) Chronic Nephritis with Exudation. The urine is often dimin ished but may be increased in quantity ; its specific gravity is low. The condition of the arteries and heart is not constant. The arteries may be full and tense, or small and tense, or full and soft, or small and feeble. The heart's action may be exaggerated, or feeble; the valves may be diseased, or the left ventricle hypertrophied. The headache can sometimes be relieved, but late in the disease nothing will control it. The arterial dilators are of use only when the pulse is tense. The cardiac stimulants may do good when the heart's action is feeble. Thorough daily sweating is sometimes efficient. Purging can give temporary relief. Opium may be the only drug that is of any use. Mild cases can be relieved by improving the action of the digestive tract.
(d) Chronic Nephritis without Exudation. The headache and sleeplessness are especially frequent and severe with this form of nephritis. The urine is often diminished, but may be increased or normal in quantity ; its specific gravity is low. The condition of the heart and arteries is liable to the same variations as in chronic ne phritis with exudation, but a full, tense pulse and an hypertrophied left ventricle are more regularly present. The first attack of headache can usually be relieved, but each successive attack is more difficult to manage.
2. Hemiplegia and Aphasia.—These two symptoms, which may occur separately or together, are seen in patients who have chronic nephritis without exudation, and in women with puerperal eclampsia. The invasion of the hemiplegia is sudden and it is usually accom panied by coma. There is loss of motion alone or of both motion and sensation. The hemiplegia, coma, and aphasia may continue up to the time of the patient's death, or disappear after a few days. In the latter case the patient may have several such attacks. In chronic nephritis the hemiplegia may occur either early or late in the course of the disease. In these patients chronic endarteritis, especially of the cerebral arteries, is very regularly present. I think that it is probable that the hemiplegia is due to the endarteritis, rather than to the kidney disease.
The treatment of this condition is not satisfactory. If there is well-marked arterial tension it may be proper to try and reduce it, otherwise it is better not to interfere.
3. Sudden Blindness.—Besides the loss of vision due to nephritic retinitis, there may be a sudden blindness which lasts for hours or days. In these patients no anatomical changes in the eyes have been discovered. This form of blindness is not uncommon in puerperal eclampsia; it occurs in a moderate number of the cases of chronic ne phritis. We do not understand the nature or treatment of this blind ness; fortunately it only lasts for a short time.
4. General EpileptVorm have always attracted much attention as one of the most terrible and dangerous of the re sults of kidney disease. They may accompany : (a) Puerperal Eclampsia, either with or without nephritis, com ing on either before, during, or after labor. At the time of the at tack the urine is sometimes diminished or suppressed, sometimes of normal quantity. The arteries are regularly full and tense, the heart's action is exaggerated, the skin is congested. It seems to be generally conceded that in these patients the convulsions are not all due to the same cause. There is also a substantial agreement as to the best methods of treatment. General blood-letting for the pa tients with excessive venous congestion, chloroform inhalations for the irritable patients, and the drugs which dilate the arteries are the routine treatment.