=Symptoms.=--Acute Bright's disease may develop suddenly with pallor
and puffiness of the face owing to dropsy. The eyelids, ankles, legs,
and lower part of the belly are apt to show the dropsy most. There may
be nausea, vomiting, pain and lameness in the small part of the back,
chills and fever, loss of appetite, and often constipation. In
children convulsions sometimes appear. The urine is small in amount,
perhaps not more than a cupful in twenty-four hours, instead of the
normal daily excretion of three pints. Occasionally complete
suppression of urine occurs. It is high-colored, either smoky or of a
porter color, or sometimes a dark or even bright red, from the
pressure of blood. Stupor and unconsciousness may supervene in severe
cases. Recovery usually occurs, in favorable cases, within a few
weeks, with gradually diminishing dropsy and increasing secretion of
urine, or the disease may end in a chronic disorder of the kidneys. If
acute Bright's disease is caused by, or complicated with, other
diseases, the probable result becomes much more difficult to predict.
=Treatment.=--The failure of the kidneys to perform their usual
function of eliminating waste matter from the blood makes it necessary
for the skin and bowels to do double duty. The patient should remain
in bed and be kept very warm with flannel night clothes and blankets
next the body. The diet should consist wholly of milk, a glass every
two hours, in those with whom it agrees, and in others gruels may be
substituted to some extent. The addition to milk of mineral waters,
limewater, small amounts of tea, coffee, or salt often makes it more
palatable to those otherwise disliking it. As the patient improves,
bread and butter, green and juicy vegetables, and fruits may be
permitted. An abundance of pure water is always desirable. The bowels
should be kept loose from the outset by salts given in as little water
as possible and immediately followed by a glass of pure water. A
teaspoonful may be given hourly till the bowels move. Epsom or
Glauber's salts are efficient, but the compound jalap powder is the
best purgative. Children, or those to whom these remedies are
repugnant, may take the solution of citrate of magnesia, of which the
dose is one-half to a whole bottle for adults. The skin is stimulated
by the patient's lying in a hot bath for twenty minutes each day or,
if this is not possible, by wrapping the patient in a blanket wrung
out of hot water and covered by a dry blanket, and then by a rubber or
waterproof sheet, and he is allowed to remain in it for an hour with a
cold cloth to the head. If the patient takes the hot bath he should be
immediately wrapped in warmed blankets on leaving it, and receive a
hot drink of lemonade to stimulate sweating.
For treatment of convulsions, see Vol. I, p. 188.
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