Chronic Brights Disease

child, bowels, time, free, iron, patient, renal, suitable, recommended and useful

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Treatment.—In cases where we find deficient secretion of urea, without albuminuria or signs of organic renal disease, we should take care to un load the bowels by free purgatives, unless, as in the case before referred to, the child be just convalescent from typhoid fever. In ordinary cases gray powder and jalapine may be given in closes suitable to the age of the child. He should be made to drink freely of some harmless fluid, and thin barley-water sweetened and flavoured with vanilla is very useful as a mucilaginous diuretic. The aperient should be repeated as often as seems desirable to ensure complete relief to the bowels ; and in addition the pa tient may take a mixture containing citrate of potash with tincture of nun vomica, or a few drops of tincture of rhubarb. The child should not be allowed too much animal food. Fish is better for him than butcher's meat, and he should take plenty of milk and green vegetables. If broth be allowed it must be perfectly fresh, and not be made from " stock." If there be anaemia in these cases, iron can be given after a time.

If a child be the subject of undoubted renal disease, it is of the utmost to attend to the working of functions the impaired action ofwhich will increase the labour of the kidneys. The skin should be en couraged to act by a daily tepid bath, by warm clothing, and by careful avoidance of the causes of chill. The patient should be dressed from head to "foot in flannel or other warm woollen material, and should take regular exercise in the open air. The bowels, if inclined to be costive, should be kept relieved by aperients ; and small doses of senna, or podophylline and belladonna, or a nightly dose of Hunyadi Janos water, as recommended in the chapter on constipation, are very useful. The patient should eat sparingly of flesh meat ; but milk and fish are suitable, and a due propor tion of farinaceous and vegetable matters should be included in his diet. If the amount of albumen is great, it may be advisable to put the child for a time upon a diet consisting merely of milk and bread. Certainly in such cases animal food should be taken with caution, and should not be allowed every day.

Climate is a matter of very great importance in cases of chronic renal disease. If possible, the child should be removed for the winter to a neighbourhood where the air is fairly warm and dry. Here he can pass his time out of doors without risk of chill, and the beneficial influence of such a change is often very remarkable. The albumen and casts may quite disappear from the urine, and for the time, at least, the health may seem to be completely restored.

Of medicines, iron is the best remedy, and the perchloride the best preparation. This salt has a distinctly diuretic action, especially if well diluted with water. Its influence in promoting the renal secretion is in creased by the addition of dilute acetic acid and solution of acetate of ammonia, as suggested by the late Dr. Basham (see page 730). The draught may be sweetened by glycerine or by a few drops of spirits of chloroform.

If an 'attack of acute Bright's disease come on, with elevation of tem perature, oedema, and head symptoms, relief may be speedily obtained in the majority of cases by free purgation and packing in a blanket bath, as recommended in cases of scarlatinous nephritis (see page 46). The in fluence of energetic purgation, too, is most striking; nothing relieves head symptoms so quickly as a good sweeping aperient. A useful form is the combination of compound jalap powder with compound scammony pow der. Enough should be given to produce four or five copious evacuations. Elaterium is too uncertain in its action to be suitable for children.

If the albuminuria persist after an attack of the acute disease, iron should be given directly the temperature becomes normal. The drug may be usefully combined with strychnia and arsenic. A child of eight years old may take three times a day twenty drops of the liq. ferri perchloridi• with two of liq. strychnine and four of liq. arsenicalis iu a large wineglass ful of water sweetened with glycerine. This medicine should be given directly after food, lest it cause nausea. Gallic acid has been recommended, but on account of its tendency to constipate often seems to do more harm than good. The first necessity in these cases is to promote free excretion from the bowels. If this function be interfered with, no medicine can be of much value. On this account iron often seems to act better if given in the form of the sulphate with sulphate of magnesia and dilute sulphuric acid ; but the other form is equally, if not more, serviceable, if care be taken to keep the bowels free. In obstinate cases fuschine (the chloro hydrate of rosaniline) is said to hasten the disappearance of the albumen after an acute attack. This den may be given to a child in closes of from two to five grains. It tinges the urine of a reddish colour. Recently, chloral hydrate has been given with the same object. It can be prescribed to a child of five years of age in doses of three or four grains three times a day.

A fatal ending in uncomplicated cases of chronic Bright's disease from exhaustion and dropsy must be rare in the child. I cannot remember having met with such a case except in connection with amyloid disease, and there the general distribution of the degeneration furnishes other rea sons for the condition of the patient. Chronic kidney disease is usually fatal in young subjects through the occurrence of some inflammatory com plication. Pleurisy and pneumonia in such cases are excessively danger ous. They must be treated with stimulants and counter-irritation. The chest and back should be repeatedly dry-cupped ; the bowels should be freely acted upon, and the strength of the patient must be supported by suitable quantities of unsweetened gin.

If the dropsy in any case be copious, it must be treated as recommended under the head of Scarlatinous Nephritis (see page 46). Pilocarpine is sometimes useful in these cases. Occasionally it may be necessary to puncture the legs with Dr. Southey's trocars.

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