BRIGHT'S DISEASE, Acute.
Rest must be given to the acutely affected renal organs, any attempt to stimulate the kidney by diuretics in this condition being liable to increase the congestion and to cause suppression of urine.
The patient should be ordered to take to his bed as soon as the physician is satisfied about the nature of his attack; he should be enveloped in a light flannel sleeping-suit, and have a blanket placed above and beneath him, linen and cotton shirts being objectionable where the functions of the skin require to be encouraged.
Food should consist entirely of milk, administered frequently in small quantities, and the total daily amount need not exceed 2 pints at first. The thirst which is often present may be assuaged by diluting the milk with barley water, or effervescing soda, or potash water. Potus Imperialis may be freely administered between the doses of milk, as there is little danger of the ingestion of fluids embarrassing the kidney unless extensive anasarca be present. By these means the high specific gravity of the urine is decreased, and the renal organs are relieved; even with a con siderable amount of dropsy it is a mistake to prohibit liquids, as the free use of water tends towards the flushing of the renal tract, and the elimina tion of effete products, or the removal of epithelial detritus, and the recommendation to prohibit Chlorides is equally unnecessary. Butter milk, two days or more old, alone or mixed with potash water, affords a most grateful means of dealing with the acute stage of the attack. Animal foods, soups, broths, and eggs, as well as alcohol, in every form should be strictly prohibited, but after a few days farinaceous food may be permitted. In the presence of symptoms of acute uraemia, the milk may for 24 or 48 hours be replaced by plain effervescing soda water given in fair amount.
Recognising that the excretory function of the renal cells is in abeyance, the physician should aim at the elimination of the retained toxic products in the blood by stimulation of the functions of the skin and bowel.
Diaphoretic drugs are much less reliable than the hot pack or hot-air bath. These may be employed as the patient lies in bed in the horizontal position. The hot-air bath, consisting of a large copper spirit-lamp, enclosed with wire gauze as in the Davy lamp, and protected by a wooden cradle to support the bed-clothing, should be placed between the patient's knees. The spirit being ignited, the blankets should he lightly tucked in, only the face being left uncovered, and soon a high temperature of the confined air is obtained (r3o° F. answers all purposes). The apparatus in constant use in all hospitals is safer; this is usually made of tin. The spirit-lamp has attached to it a long bent chimney or wide telescope-tube, which permits the spirit being ignited on the floor of the sick-room; the heated air passes through the tube, which is introduced beneath the bed clothes; all danger of fire from the upsetting of the lamp in the bed is thus avoided. The electric lamp bath may be likewise used. The ordinary hot-water bath (roe F.) may he resorted to in the absence of these appliances, but the danger of syncope induced by the removal of the patient to bed and the risk of chills are serious drawbacks to its use.
The patient may be permitted to remain in the hot-air bath for about 3o to 4o minutes, by which time usually copious perspiration will he in duced, and he may have abundant warm, diluent drinks to encourage the sweating. Any symptoms of cardiac depression must be instantly met by the withdrawal of the lamp, and by sprinkling the face and hands with cold water. The bath may be repeated daily, and the temperature increased, as well as the duration of the bath lengthened according to the effects produced; after the bath the skin should be dried with warm towels and the following diaphoretic mixture administered with the view of keeping up the action of the skin: 11. Lig. Ammon. Acet.