Sixteenth clay: Traces of albumin in the morning urine; at noon temperature rose to 39.2'; vomiting at one o'clock, followed by continued retching. General weakness; face puffy.
Seventeenth day: Increase in body weight of one kg. Twenty four hours urine only half the normal amount. (about 400 c.c.); contains one-quarter per cent. albumin; no sediment. Heart action slow (bradv cardia).
Eighteenth clay: Urinary sediment contains many granular and a few hyaline casts. Pulse, 72 (had been wavering between 90 and 120).
Twentieth clay: Maximum body weight, 3 kg.; oedema; urine red dish in color; much sediment containing epithelial and granular casts, a considerable number of red blood corpuscles, blood platelets, and per cent. albumin. Pulse in the morning, 90; headache and lassitude during the day. At 12.30 A.M., muscular twitching, beginning in the face muscles, extending quickly over the entire body, most pronounced on the right side. Loss of consciousness, face pale, lips cyanotic, foaming at the mouth. Pulse, 150. Continuous convulsions at midnight. Vene section, removing about 200 c.c. of blood through the right median vein. Infusion of 200 c.e. physiologic saline solution into skin of abdomen. Convulsions less frequent and at longer intervals. Slight twitching until 4 A.M.
Twenty-first day: Weakness, sensorium unimpaired. Occasional twitchings of slight degree; retching. Fifteen to twenty green, fluid stools, containing mucus. Drank during day I liter Biliner water. Urine, about 250 c.c.; bloody. Sediment as before.
Twenty-third day: Body weight, 1.7 kg. less. Continued diar rhcea. Urine scanty; very bloody.
On the twenty-fourth day urine increased in amount (without medication other than venesection); 2000 c.c. voided on thirty-second day. No sediment since nineteenth (lay; no albumin after thirty-second day. Convalescence; great gain in weight. Discharged on forty-ninth day.
The particular danger to be apprehended from a nephritis is the appearance of uriemia, which often, as in this case, occurs suddenly in the course of an apparently mild case. As a rule, however, the ummic symptoms are preceded for several days by mild disturbances, such as continuous headache, severe colic, retching, eyes staring, slow pulse of high tension.
An additional danger to be feared in these cases is weak heart action. Irrespective of the anxiety shown by the patient in cases of heart failure, which is more or less of a subjective nature, arc the respiratory symp toms, such as frequent superficial respiration, and cyanosis of the mucous membranes. In the most severe cases death occurs with symptoms of pulmonary oedema.
Julius IL, three years old. Light attack of scarlet fever. Beginning on the eleventh day the pulse is arrhythmic, slow, 64, in spite of rise in temperature and swelling of the lymph-nodes.
Fourteenth day: Traces of albumin.
Sixteenth day: One per cent. of albumin, bloody urine, increase in body weight.
Eighteenth clay: Dyspncea in the evening. Orthopncea: blood pressure, 105 min. (Giirtner).
Twentieth clay: Evening temperature, 41° C. (105.5° F.); pulse, 192; increased dyspncea; cyanosis of mucous membranes; mental facul ties unimpaired. Sputum foamy.
Twenty-first day: Temperature 40.6° C. (105° F.). Death in the afternoon, with clonic convulsions.
Dyspncea is not always a symptom of pulmonary oedema. It may accompany a bilateral hydrothorax, especially when there arc present evidences of pleurisy.
Adolf G., five years old. had scarlet fever three weeks ago. Ne phritis, with bloody urine; two per cent. albumin ; typical sediment. Dul ness over both lungs, especially posteriorly, from the seventh dorsal vertebra on downward. Distinct pleural friction sound above the line of dulness. Cardiac area of dulness increased markedly laterally (to the right sternal border on the right-, and on the left to the apex, which is in the mammary line, to the fifth intercostal space outside of the mam mary line). No pericardial friction sound. Liver dulness, 4 cm. below the costal border. Pulse small, soft, of poor tension. Dyspnon and cyanosis. Diagnosis: Nephritis, with secondary inflammatory proc esses of both hydrothorax; hydropericardium; weak heart. Rapid improvement on the administration of digitalis. Seven days later the heart is normal. Kidney lesion healed after seven weeks.