Persons that take considerable exer cise may have considerably more food than those who are stout or who lead sedentary lives. Gastric disorders re quire a liquid diet until the digestion is restored, or the elimination of all but the soft and bland foods. All extremes of activity (bodily, mental, and emo tional) are to be avoided.
After violent muscular effort, there is an increase in the quantity of leucocytes and epithelial cells normally found in urinary sediment, and likewise the apparition of cylinder-casts. Penzolt (AItinchener med. Koch., Oct. 17, '93).
Physical exercise should be moderate and regular, and, if the climate be warm and dry, it should be taken in the open air. The patient should never be sub jected to the vicissitudes of worry, anx iety, or to the tension of competition. Indulgences of whatever nature, if they tend to unbalance self-control or disturb the equanimity of the patient, must be strictly prohibited.
Often life may be prolonged by a change of residence to a warm, dry, and mild climate, since the variability and humidity of temperate climates, particu larly during the winter season, tend to aggravate the disease. A sea-voyage or a sojourn at some southern European re sort may be very beneficial.
Medicinal treatment is employed for the following indications: The bowels should be kept free by the assistance of laxatives or by laxative alkaline mineral waters. Papoid, peptenzyme, and other digestants, with bitter tonics, are useful in cases of furred tongue and indigestion. Acids or alkalies, according to their spe cial indications, may also be used simul taneously.
High vascular tension is to be met by the cautious use of nitroglycerin in grad ually increasing doses, beginning with 1 minim three or four times daily, until all danger of rupture of the vessels is over.
Nitroglycerin for a considerable length of time, so proportioning the dose that the intervals shall be comparatively short,—never less than four times daily, —and the amount never more than that just necessary to cause the slightest feel ing of fullness in the head or to slightly quicken the pulse. In this way a re markable tolerance of the drug is ob tained. Stewart (Then Gaz., Sept. 15, '93).
Among the first indications winch sug gest themselves considering the cardio vascular conditions resulting from renal disease is immediate and free venesection on the occurrence of urtemie convulsions.
Sixteen or twenty ounces of blood should be taken at once, followed by a calomel purge. If a single withdrawal of blood does not stop the convulsions it may be repeated, and recurrent urtemic con vulsions may be met by further vene section. In acute tubular nephritis bleeding on account of convulsions may be followed by immediate and remark able improvement.
A further indication for treatment may be deduced from the fact that the damage to the vessels and heart through which much of the suffering attending renal disease is brought about, and by which life is shortened, is due to high arterial tension. The reduction of the intravascular pressure ought to be an object continually held in view. For this purpose the vascular relaxants have been tried: nitroglycerin, the nitrites, and the tetranitrate of ervthrol. Un fortunately the effect of these sub stances is very fugitive; but the last named, which is slower and more per sistent in its action, may sometimes be given with advantage. The best means personally known of exercising a definite influence on unduly high intra-arterial pressure is through mercurial aperients. A dose of calomel, 3 to 5 grains. will often avert impending convulsions or prevent their recurrence: will relieve the headache, stupor. and twiteliings: and may prevent urcemic paroxysmal dyspncea in advanced kidney disease. So also a single grain of pilula hy drargyri or hydrargyri cum ereta, With rhubarb or eolocynth and hyoseyninus. once, twice, or three times a week, ac cording to the degree of tension in the pulse. exercises a favorable influence in the early sta[ms of chronic Bright's disease, both on the symptoms and on the coin-se of the disease. W. H. Broad bent (Practitioner, Nov., 1901).
The other extreme, of a very low ten sion that induces dropsy, and compli cations, usually urtemic (convulsions, dyspmca, and headache) also call for therapeutic assistance. Headache, ver tigo, and the so-called renal asthma (dyspncea) are also often relieved by nitroglycerin.