TREATMENT - ACUTE EXUADATIVE NEPHRITIS.
We have to treat an acute exudative inflammation of the kidneys, which naturally runs its course in four weeks and terminates in re covery. We have also to treat the symptoms of this nephritis— the scanty urine, dropsy, vomiting, anmmia, and cerebral symptoms. We have to treat these conditions more frequently in children than in adults, and very often. as complicating an infectious disease.
The most efficient treatment of the_ nephritis is the application of heat to the entire surface of the body. This can be done in a number of ways, but the best way is to wrap the entire body in a blanket wrung out of hot water. Such a hot pack can be used for an hour at a time once or twice a day. Of drugs the most reliable is aconite— one or two minims of the tincture every hour. It may be necessary to precede the aconite by giving one drachm of sulphate of magnesia every hour until the bowels move, or until eight doses have been taken. There are cases, in which the nephritis is not of very acute type, where digitalis seems to exert a favorable effect on the circula tion. The preferable form of the drug is digitalin in doses of one one-hundredth of a grain.
The scanty urine often causes anxiety. Of course it is better that the patients should pass a fair quantity of urine, but I think that there is a tendency to exaggerate the dangers of scanty urine and to be too energetic in giving diuretics. As the diminution in the quan tity of urine is due to the congestion of the kidneys, if we can de crease the congestion the urine will increase. The best way to do this is to apply heat to the surface of the body. The use of diuretics is to be avoided. The attempts to make up for the scanty production of urine by purging or sweating the patient have never seemed to me to be of any practical use.
The febrile movement in an acute nephritis requires no treatment. The prostration, loss of appetite, nausea, and vomiting only call for rest in bed and a fluid diet.
The anemia ought to be prevented or relieved, but, while the ne phritis is still active, I know of no way in which this can be done. When convalescence is established then the anemia. readily improves with the ordinary methods of treatment.
The dropsy is subcutaneous, and even when considerable, does lit tle harm. It disappears of itself as the nephritis subsides. The rest in bed and the hot pack are all the treatment necessary for it. To give diuretics or cathartics to get rid of the dropsy is quite use less.
The cerebral symptoms are the ones to which most attention has been directed. There can be no question that they accompany a con traction of the arteries with increased arterial tension and labored action of the heart. No matter what views one may entertain as to
the cause of this change in the circulation, I believe that treatment is best directed to the arteries themselves, rather than to the uncertain causes of their contraction. Fortunately there are drugs which stop contraction of the arteries promptly and efficiently. Of these drugs the most suitable are : aconite, nitroglycerin, chloral hydrate, and opium, preferably given in small doses and at regular intervals be fore the cerebral symptoms are marked, but in large doses hypoder mically or by the rectum to stop a severe attack.
It is wise to watch the condition of the heart and arteries, and, as soon as increased arterial tension is developed, not to wait for the manifestation of the cerebral symptoms, but to try to relieve it at once.
The way in which we manage the patients, therefore, is as follows : They are put to bed or kept in the house until the nephritis has run its course. They are put on a fluid diet, preferably milk, and the skin of the entire body is cleaned once a day. For many cases no other treatment is necessary.
If vomiting is troublesome it can usually be controlled by adding oxalate of cerium and bicarbonate of soda to the milk. For the rest lessness and sleeplessness chloral hydrate, the bromides, or opium may be employed.
If the nephritis is of severe type the patient is wTapped in a blanket wrung out of hot water and kept in it for one hour either once or twice every day. In addition we give one drachm of sulphate of magnesia every hour until the patient has taken eight doses or the bowels begin to move. This is followed by one or two minims of tincture of aconite every hour.
Throughout the disease we watch the pulse, and as soon as it shows any increased tension give chloral hydrate in doses of from two to five grains every three hours.
If severe headache, muscular twitchings, or general convulsions occur, to most of the patients we give chloral hydrate in doses of from 5 to 20 grains by the rectum, or nitroglycerin in doses of from to of a grain hypodermically, or morphine in doses of from to lc of a grain hypodermically. In strong and robust adults with a good deal of venous congestion general blood-letting may be advisa ble. For the relief of the convulsions urethane in solution, given in repeated closes up to 100 grains in twenty-four hours, is said to be of service.
As the nephritis subsides the milk is gradually replaced by solid food, and iron and oxygen are given.