Page:The American Cyclopædia (1879) Volume I.djvu/281

ALBUMINURIA 257 passed is deficient in urea. The urea which should be eliminated by the urine accumulates in the blood and poisons that fluid. The serum of the blood, of which the albumen is drained off by the kidneys, becomes deficient in that sub- stance, and of lower specific gravity. The pal- lor of the complexion shows that the blood is deficient in coloring matter; and where the disease has lasted a short time, this is confirmed by direct examination, the blood globules be- ing diminished in proportion. The circulation of a poisoned blood throughout the body causes that liability to secondary diseases which so strikingly characterizes the complaint. While acute albuminuria is always a serious disease, still in a large proportion of cases we can look forward hopefully to the recovery of the pa- tient; yet it must always be borne in mind that at any time secondary disease may be lighted up, which will seriously complicate the case and increase the danger. The existence of the strumous diathesis in a marked degree, or of debility from previous illness, is likewise an exceedingly unfavorable circumstance. The more recent the disease, the better is the pros- pect of recovery ; while the persistent presence of albumen in the urine after a certain time leads us to fear the occurrence of chronic de- generation. The albuminuria following scarla- tina generally terminates favorably, and there is no tendency to a return of the disease. When convalescence commences, the urine be- comes more copious and pale, and for some time is discharged in large quantity, while the albumen gradually diminishes ; but the patient cannot be considered as safe, so long as any trace of albumen can be detected in the urine, or any epithelial casts are discovered under the microscope. The hygienic treatment of acute albuminuria is sufficiently simple. The patient should be clothed in flannel, and if possible confined to bed ; the room should be of a com- fortable and equable temperature, and the patient should be most sedulously guarded against exposure to cold currents of air. Throughout the course of the disease, the diet should be unirritating and digestible ; any ex- cess in this respect may be attended with bad consequences. When convalescence is estab- lished, the preparations of iron will be found exceedingly useful, improving the condition of the blood and the general strength. Chronic A Ibuminuria. The approach of chronic albumi- nuria, when not the sequel of an acute attack, is masked and insidious, rarely awaking atten- tion until fatal progress has been made; in- deed, persons not suspecting themselves to be ill have in repeated instances died suddenly of what has been supposed to be an apoplectic at- tack, and post-mortem examination has shown the kidneys and not the brain to be the seat of mischief. In general, however, the symptoms are sufficiently well marked to attract the at- tention of the observing physician. The pa- tient loses flesh and strength ; the appetite fails, or, if good, flatulence and other dyspep- 18 VOL. i. 18 tic symptoms are present; after a time the color is lost, and the patient has a pallid, sal- low, or waxy look ; the skin becomes dry ; in the morning, on rising, swelling beneath the eyes is noticed, and at night the ankles are oedematous. There is some pain in the back, but it is not commonly so great as to attract attention. If the patient be questioned, it will be found that there is some irritability of the bladder ; he has, contrary to his wont, to rise at night to pass urine, although there is no evi- dence of disease of the bladder itself. The urine is sometimes passed in large quantities, and occasionally the amount is much below the average ; it is pale and of low specific grav- ity, varying commonly from 1-004 to T012. Tested by heat and nitric acid for the presence of albumen, this substance is found to vary greatly in amount in different cases, occasion- ally being present in large quantity, while sometimes only a trace of its existence is dis- covered; sometimes it disappears altogether, and will only be discovered after repeated ex- aminations. In the course of the disease drop- sy of the abdomen is apt to occur, and this often becomes so great as to be the principal source of suffering. Anasarca is also present, and the whole cellular tissue is infiltrated with serum. As hi the acute form of the disease, there may be effusion, with or without inflam- mation, into the cavities of the pericardium and pleura, as well as into that of the perito- neum. A tendency to prolonged somnolence is often observed, and this may lapse into coma, or may alternate with epileptic convulsions. Bronchitis is apt to occur and to prove severe and intractable; pneumonia, too, sometimes comes on insidiously, and may run on rapidly to a fatal issue ; and rheumatism, particularly a chronic and unmanageable form of the dis- ease, is not infrequent. It is to the deteri- orated condition of the blood that the number, variety, and fatality of the complications of the disease of the kidneys are to be attributed. The principal alteration in that fluid would seem to be chiefly the diminished amount of the blood globules, the hematine, according to Dr. Christison, sometimes reaching only one third of its natural quantity, and the presence of the retained urea. The duration of the dis- ease varies very greatly in different cases. Among the laboring classes whose avocations lead them to exposure to the inclemencies of the weather, and in whom sickness brings too often privation of comforts and mental depres- sion, death commonly occurs after no very pro- tracted period ; but among those whose posi- tion enables them to avoid fatigue and exposure, and who are more on their guard against the first invasion of disease, chronic albuminuria often lasts for years, leaving its victims a very fair measure of the enjoyments and labors of life ; their situation, however, is always preca- rious, and serious or fatal disease may at any moment be brought on by apparently trivial circumstances. Intemperance hi eating and