NEPHRITIS The mild grades of nephritis do not require any special treatment. We have observed a large number of cases in which no treatment was given, not even diaphoretics, and found that the oedema and albuminuria disappeared as rapidly as in eases where we resorted to packs and internal medication. Other cases were as protracted in duration with medication as without. Therefore, we have arrived at the conclusion that the course of a scarlatina' nephritis is not influenced by treatment in any way.
It is important, however, to insist on absolute rest in bed. This measure alone controls the albuminuria. It is increased in degree when patients are permitted to walk around too soon. A meat-free diet is enforced as long as there is a trace of albumin in the urine, unless there is established an intolerance to a milk diet, and in the very protracted cases. These are the only exceptions to our rule.
The salt-free diet, instituted in France for the treatment of chronic nephritis, failed to yield any favorable results in our clinic, even as a prophylactic measure. An extensive observation of this method of treat ment has convinced us of its ineffectiveness. When nephritis has developed, only the oedema is influenced by the salt-free diet; therefore, it should not be prescribed until nephritis is present.
The method of procedure is as follows: The diet consists of milk, malt coffee, unsalted milk and flour foods, unsalted soup, bread, butter, honey, fresh fruits, stewed fruits, potatoes, etc. (See Vol. I, Feeding of Infants over One Year Old. Also the table in the Appendix, showing Cl. content of foods.) The complications of nephritis are treated symptomatically. The use of cardiac tonics is productive of good results in eases of heart weakness.
One phase of a severe nephritis demands the closest attention and observation and immediate treatment—urtemia. Delays and remissness in promptly instituting remedial measures may prove dangerous.
When the convulsions become more severe and more frequent, and unconsciousness supervenes, or symptoms of pulmonary oedema appear (severe dyspncea, foamy sputum), we resort to venesection. Owing to the small size of the cubital veins of children, this procedure is sometimes difficult. We also give a subcutaneous infusion of 200 to 300 c.c. of physiologic salt solution, or high colonic injections of lukewarm water. Hot packs should not be resorted to in urmemia.
We have given up leeching because of the bleeding following the removal of the leeches and the danger of infection when the skin is edematous.
The result of venesection in urtemia is, as a rule, most gratifying. (See case of Robert M., p. 297.) Gabriele C., ten years old. Moderately severe attack of scarlet fever. Nephritis on the twenty-first day. Twenty-fourth day: Head
ache, prostration and restlessness, followed by a slight and then a severe urtemic convulsion. Unconsciousness. Venesection. Withdrawal of 300 c.c. of dark-colored blood. Transfusion of 200 c.c. of saline solution in right abdominal wall. Moderation of convulsions during veucsection. After an hour. patient was quiet ; slept for two hours and on awakening was fully conscious.
If convulsions again set in, the venesection is repeated.
In the case of Rosa M., seven years old, venesection had to be done three times; SO c.c. of blood were withdrawn the first time; 100 c.c. the second time, and 300 c.c. the third time. Improvement after each operation; no convulsions after the third withdrawal.
The good results of venesection are by no means certain.
John T., nine years old. Brought to the hospital in convulsions. Died four hours after the withdrawal of 250 c.c. of blood, in spite of immediate stimulation with camphor and caffeine.
It is as yet impossible to prevent the occurrence of nephritis. There is no prophylactic treatment. Even in spite of the greatest. precautions to prevent chilling of the body surface, and the most watchful care of the diet, nephritis will occur. So far as our experience goes, so-called prophylactic agents (oleum tercbinthime, hexamethylenamine) recently come into vogue are useless.
Our statement that every child should be kept in bed for four weeks has reference to uncomplicated cases only. The onset of complications will, of course, make a longer stay in bed necessary. In such cases we keep these children in bed for one week after the temperature has become normal and the urine is free from albumin for a similar period. The diet is increased, a mixed diet is given; the temperature is taken in the morning and at night, and the urine is examined daily. Baths are given freely during this time. Elevation of temperature frequently occurs when the child is allowed to get up out of bed. It is then necessary to enforce rest in bed again for a few days, until the temperature is normal once more. In from one to two weeks the child is allowed to go out of doors.
Although the course of scarlet fever is exceedingly deceptive, unlike measles it is rarely followed by chronic infections; particularly does it not predispose to tuberculosis. Children who do not succumb to the original infection do not, as a rule, suffer from any permanent disability. Eight weeks after the beginning of the disease they are as well as they were before.
The single exception to this statement, one which unfortunately is met with comparatively frequently, is a chronic otorrhcea, with impaired hearing. Functional disturbances the result of damaged heart valves or kidneys occur but seldom.