The commonest cause is exposure to cold and damp. It occurs frequently in the progress of scarlet fever, also during diphtheria, measles, typhus, and erysipelas, and other diseases. It may follow excessive drinking. Intemperate habits greatly favour its occurrence.
The symptoms of this acute attack are as a rule comparatively sudden in their onset. Chilli ness followed by shivering fits and fever, accom panied by headache, thirst, dryness of the skin, sickness and vomiting, are the indications of some serious disorder. The seat of the disease is specially marked out by aching across the loins, it may be mere uneasiness or dull pain. Dropsy, however, is one of the most important signs. It comes on often rapidly, and is spe cially observable in the face, which becomes puffy, and has a peculiar blanched look. It is earliest seen in the eyelids, and is also common about the ankles, and may be so great as totally to alter the appearance of the patient. The urine undergoes decided alterations. It is diminished in quantity, though it may be passed more frequently than usual, is high-coloured, and has a copious sediment. Examination (p. 406) reveals the presence of albumin in greater or less quantity, blood also and tube casts (p. 407). A sense of heat and pain gener ally accompanies its discharge. • In. very severe cases the secretion of urine almost or quite ceases. This is termed suppression of urine, that is, no urine is formed by the kidney, and is to be distinguished from retention of urine, in which urine is formed, but some obstacle to its discharge exists. Resulting from suppression is the condition termed uraemia, a condition due to the retention of waste matters in the blood which the kidneys ought to separate out, but are rendered unable to do. Its symptoms are headache, mistiness of vision, noises in the ears, oppression, dulness, drowsiness, sometimes delirium and convulsions, and it ends in com plete unconsciousness (coma) and death. Now, setting aside the symptoms of suppression of urine, the others that have been noted would leave no doubt as to the nature of the disease, and prompt treatment would be necessary. But the symptoms are not so marked in every case. In some cases previous signs of an inflam matory disease are absent and there is no marked pain, the symptoms being limited to dropsy and alterations in the urine. Never
theless dropsy and scanty albuminous urine are sufficient to warrant the conclusion of the presence of Bright's disease. The symptoms of recovery are lessening of the dropsy, increase in the quantity of the urine, which contains a diminishing quantity of albumin, the skin becoming more moist and of a healthier colour. Recovery may take place speedily within one or two weeks, or may be gradual, occupying several weeks or even months, or the case may pass into a chronic form.
Treatment.—The patient should be kept strictly to bed, clothed in flannel, and his room should be kept warm. Hot applications, poul tices containing mustard, if the attack is acute, are useful over the loins; but or tur pentiue cloths should not be used. The action of the bowels and skin should be aroused. This is done by giving from 20 to 60 grains of the compound jalap powder, repeated every morn ing or every second morning, as seems desirable. The action of the skin is aided by doses of solu tion of acetate of ammonia (a dessert-spoonful) and spirit of nitrous ether (half a tea-spoonful) repeated every three or four hours. But for this purpose nothing is so useful and so safe as a hot pack. The patient is rolled, naked, in a blanket wrung out of hot water, and is then surrounded by warm dry blankets. He should be kept in it for an hour or much longer if he feels comfortable. On the hot pack being re moved the person should be quickly dried with warm cloths and enveloped in warm flannels. In the absence of medical advice this is the simplest and safest treatment to pursue when ever the symptoms seem urgent. The patient ought also to have plenty of water, lemonade, barley-water, milk, &c., to drink, to help in washing away the material that tends to block up the tubules of the kidney. His diet should be mainly of milk and similar light material. On recovery great precautions must be exer cised, as the least exposure might produce a relapse. Flannels should be worn. The food should continue to be of the simplest kind for a long time, milk, rice, bread, plenty of butter, and all kinds of milk puddings without eggs. Quinine and iron should be administered to restore strength and tone.