Sfit. ,Etheris :ivj.
Aqua' Camphom ad 5viij.
Ft. mist. ciejas capiat coclzleare maytion omni Nora.
If feverishness be present and no cardiac contra-indication obvious, min. Tincture of Aconite may be added to each dose with advantage.
When urxmic symptoms threaten, or when convulsions have already appeared, the hot-air bath should not be relied upon, but resort should be made to the more rapidly acting hot pack. A large tub or bath, half filled with almost boiling water, being carried into the sick-room, a few ounces of Mustard previously blended with cold water are mixed with the contents, after which a large double thick blanket is thrown in, and in a few minutes wrung out by two nurses to get rid of superfluous moisture. In this the patient is completely enveloped, all but his head; there is little danger of scalding, since the heat is rapidly reduced by the evapora tion from the large surface and the blanket may be with safety as hot as the hands of the attendants can tolerate in the wringing process. Enveloped in this manner, the patient is placed upon a mattress or palliasse of straw, and covered over with blankets, sheets, or counterpanes, where he may be permitted to remain for one hour, or even more, till a free amount of perspiration has occurred, during which period copious draughts of water may be administered.
Where suitable appliances are not readily obtainable, Sir Jas. Simpson's poor man's bath is a useful expedient. It may be made by filling a large number of soda-water bottles with very hot water, over each of which a woollen stocking, squeezed out of hot water, is drawn; these are placed alongside the patient's body and limbs under the bed-clothing.
Pilocarpine is the most powerful known diaphoretic, and its hypodermic administration is clearly indicated in the urwmie condition, but its in judicious use has so frequently caused serious pulmonary oedema and even death that many physicians have condemned its employment. Some years ago the writer drew attention to the fact that if the drug he administered to a patient whilst in the hot pack, after the action of the skin has been started,there is practically no danger of lung trouble supervening; gr. may be given under these conditions with safety. Should symptoms
of cardiac depression show themselves a hypodermic of Strychnine will be indicated.
The patient should be transferred to another bed with warm flannel blankets after the hot pack, his skin haying been rubbed dry with hot towels. The immediate and urgent symptoms having been thus relieved by the powerful stimulation of the skin. Saline Purgatives if not already administered should be given, and they should be resorted to as a routine in every case of acute Bright's disease with a view of causing the elimina tion of retained products by the bowel. Sulphate of Soda or Magnesia in t-oz. doses dissolved in half a tumblerful of aerated water may be given twice daily, or smaller amounts more frequently to keep up copious watery evacuations. Cream of Tartar alone or with compound powder of Jalap is preferable where much anasarca exists; Calomel or Blue Pill should not be given in the acute stage of renal diseases. In most cases the following mixture may be relied upon ; the method of treating anasarca by concentrated solution of mtg. sulph. will be described under chronic Bright's disease.
R . flag nesii Sulphatis Magnesii Carb. Pond. 3iij.
A qute Menthte Pip. ad ,;xij. illisce.
FL mist. Signa.—" A large wineglassful every 3 hours till purging occurs, then half a wineglassful every 4 hours to keep vp the discharge of watery motions.'' When urmic convulsions continue in spite of the above treatment, the question of Blood-letting must he considered, and the physician should not hesitate to open a vein at the elbow and remove oz. blood or more. At the same time he should inject at least twice as much warm Saline Solution into the vein or hypodermically into the loose cellular tissue of the body at several spots without pausing to consider whether the formidable symptoms are due simply to retained urea or to the pres ence of some toxin in the blood. The serum by diluting the remaining blood in the body prevents its concentrated action on the nerve centres, and may save life which would otherwise be sacrificed even when vene section has been employed.