CHAPTER V. BRIGHT'S DISEASE (ALBUMINURIA). |
  In its later stages, this is one of the worst forms of disease. It is often said to be caused by “cold.” There can be no doubt but what a person whose kidneys are already badly diseased, and, consequently, his whole system depraved, may have a violent illness excited by extreme exposure to wet and cold. The same may be said in case of one reduced by any exhausting form of disease; but sound-bodied men, living hygienically, could never have this disease, whatever the degree of cold they might have to endure. On the contrary, this disease is not known among the residents of the polar regions; our own explorers among the ice-fields of the north do not have it, although exposed for long periods to a temperature at 40° to 60° F. below zero, and to changes of so extreme a character that our temperate climate affords no parallel to them. “In the accounts of Arctic expeditions, though the most intense cold was often endured, under circumstances of great fatigue, by men previously weakened by disease and hardship, this is not among the diseases from which they suffered. Dr. Kane’s men, though enduring extreme cold, exposed on one occasion for seventy-two hours at a mean temperature of 41° below zero, suffered fearfully from frost-bite and scurvy, but not from any renal affection. Other travelers within the Arctic circle bear the same testimony, and I have been informed by those familiar with the cold districts of North America, that there renal dropsy is unknown.”[41] “The travelers in the frigid zone are exposed to far greater and more sudden transitions of temperature than are ever felt in our changeable but temperate climate. Capt. Parry states that his men often underwent a sudden change of 120°, in passing from the cabin of the vessel to the outer air, and yet none but the most trifling complaints resulted. Here we have all the circumstances from which experience would lead us to anticipate renal disease, viz.: great preceding depression, intense and protracted cold suddenly applied.... Extreme cold,” continues Dr. Dickinson (ibid.) “though it may stop cutaneous exhalation, probably does not allow the material that would cause renal inflammation to accumulate. Cold increases the action of oxygen and gives rise to increased combustion of the solids and fluids of the body. This condition, as I have emphasized elsewhere repeatedly, occasions a demand for a large amount of food daily, to supply the waste, and exalts the digestive powers correspondingly. The moral of all this, for those who, living in a temperate climate, would avoid these disorders—all physical disorders, indeed—is that here the above conditions can not obtain to the extent of rendering possible the digestion and absorption of three full meals a day. Only under exceptional circumstances are two such meals ever thoroughly digested and assimilated—they can never be, unless needed; and this fact is not disproved simply because inexperts do not recognize the symptoms of indigestion which everywhere prevail among themselves. Some of the most incorrigible workers, with both brain and muscle, known to me, take but one meal a day,[42] and this because they found the change necessary in order to enable them to perform their arduous labors and preserve their health. Others similarly situated divide this meal into two halves—taking a small meal morning and night, or, better than the latter, a lunch in the morning, and at night, after ample rest, the principal meal. No person ever tried this plan and found any need of a change because of lack of nourishment.[43] I mention this last point to meet the stock objection of people who essay to escape from the logic of the position—the necessity for the modification of their own dietetic habits—behind the old dogma, ‘one’s meat is another’s poison.’ (See p. 43.) It is entirely probable that a robust man (a frail one would succumb to the exposure, with or without food) exposed for days together, and for the entire twenty-four hours, to the extreme cold of winter, exercising vigorously meantime, could eat three full meals a day and escape digestive disorder. The habit of approximating as nearly as possible to this diet, in a temperate climate, or while the bodily warmth is maintained by artificial heat, originates the greater proportion of our ailments; while lack of exercise, and the folly of attempting to oxygenate this excessive quantity of food with air that is breathed over and over again—a process which one writer likens to eating one’s own foeces—amply accounts for the balance. “By cold the respiratory function is exalted, and the excretion of urea is diminished. With the intense cold of the North Pole (and in the open air), the introduction of oxygen by the lungs is probably so great, and the oxidation in the body so active, that all material susceptible of such action becomes oxidized, as much of it as can be converted into carbonic acid passing out with the breath. The kidneys, therefore, are not liable, as in temperate climates, to be irritated by excrementitious matter, for the stress of excretion falls upon the lungs.” (Ibid.) The practical question then is, What can we do, in this particular climate, that shall tend to give us exemption from a disease that can not exist at the poles, where the cold is intense enough to require a man to eat all he can, nor at the tropics, when the heat is met with a diet of juicy fruits?[44] (See article on Fruits.) Simply this, and nothing more; so regulate the diet as to forbid indigestion, or, in other words, eat according to our needs, as governed by work and weather; and all that has been said about the cause and prevention of “colds” (see C.) is applicable right here. Winter weather (inoperative, however, for those who spend their time in close, warm rooms), scant clothing, much exercise, fresh air—these conditions, so far as present, and to the extent of a man’s subjection to them, require a larger quantity of food than could be digested under opposite conditions, and tend to mitigate the effects of over-indulgence as to amount and quality. In our climate, however, not one person in ten thousand lives, even in the coldest weather, sufficiently under these influences to require the diet necessary at the poles, viz., three full meals of mixed food, largely composed of fat. Hence, the only palliatives a person can resort to, who adheres to the prevalent mode of living, as to diet, are those conditions that approach as nearly as possible to those obtaining in the frigid zone; but these conditions can not be, at least are not, enjoyed here, to a point rendering exemption from disease possible even for the most robust. But when we reflect upon the fact that our people are not, as a rule, robust (although this would be otherwise but for the unbalanced circumstances under consideration), that they live in warm rooms, wear heavy clothing even within doors, and don thick wraps on going out, work as little as possible (all tending to the need of abstemiousness), and that in the face of all this they do not, at least to any appreciable extent, voluntarily restrict their appetites, but do, in fact, even in summer, imitate the blubber-eaters of the North, nearer than they do the fruit-eaters of the South; that Sabbath morning finds the New Englander, for example, gorging himself with pork and beans, hot brown bread dripping with butter, hot, strong coffee, etc.; Tuesday, roast-beef, with plenty of gravy; Wednesday—“boiled mutton, with caper sauce,” and so on to Saturday’s boiled dinner, of corned-beef, greasy cabbage, etc. (the diet of the poor differing chiefly in the quality, or price per pound), and this just the same during the warmest week in winter as during the coldest, and regardless of any of the possibly varying circumstances, as hard work out of doors, or light work, or none at all, within; and that this same folly runs into and becomes greater folly in the spring and summer even, except so far as nausea or lack of appetite cause an involuntary modification,—in view of all this we need not look altogether, nor indeed at all, to heredity to account for the wretched disorders to which we, as a people, are subject, and which prevail to an extent almost transforming our literary and art periodicals into indirect partnership-relations with the manufacturers of quack “remedies” for all forms of sickness; this class of advertisers pay too liberally to exclude their flaunting lies. I look almost in vain for even a religious journal that refuses to devote any portion of its space to medical advertisements. Do our religious editors themselves believe in, and take, the “pills” they advertise? Bright’s Disease is one that never attacks those who live on coarse food, live abstemiously, and drink water chiefly. It is rather a disease of “high livers.” But a man does not need a large income to ensure this affection: any one who can get all he wants to eat and drink, and who eats and drinks all he “wants” (even without indulgence in wine, or alcohol in any form, which is a prolific cause of this disorder), may safely reckon on some of the symptoms, if not upon the worst form of the disease; and whether it be the understood cause of his death or not, it will surely be a contributing cause. The possession of typically healthy kidneys is a rare circumstance in this climate. The excessive micturition so universal in infancy, occasioned by excess in diet, is the beginning of renal disease. Dr. Bright immortalized his name by discovering the fact that, when a man’s last sickness is attended with a certain class of symptoms, as albumen in the urine, final suppression of the urine, and uremic poisoning, they are occasioned by a peculiar disease or degeneration of the kidney. From a practical stand-point we care nothing about the kind of change taking place in the kidney, but rather ask what kind of change in our habits will keep this, and all the organs of the body, in a healthy condition? The former study is all well enough for those who desire it, but if too much time is devoted to it, and to the relation of drugs thereto, by an individual, he may be, probably will be, the very least fitted to advise an inquirer who desires to know what he can do to be saved from disease and the supposed necessity of taking medicine. Says Dr. Dickinson (ibid., chap. VI.): “There are few disorders which are more under the influence of medicine than is the catarrhal inflammation of the kidneys.” And the very next sentence is one worth pondering on by those who are accustomed to take medicine whenever they come to grief through ignorance or neglect of the laws of life: “Under some plans of treatment,” says this celebrated authority, in continuing, “plans which formerly were almost universally adopted, and still have their advocates, the disorder is one of heavy mortality. Under other circumstances the danger is so small, that if once the complaint be recognized, a recovery may be reckoned upon in a large proportion of cases. Without treatment of any kind there is reason to suppose that a large majority of the subjects of it would recover.” (The italics are my own.) From this it will be observed that it depends on one’s luck whether he shall fall into the hands of a practitioner who belongs to a class still adhering to the plan ensuring a “heavy mortality,” or of one whose modified form of treatment is less fatal; and upon his good sense, whether he shall come under the influence of either, or adopt the methods indicated herein, viz., the abandonment of disease-producing, and the adoption of ease-producing, habits, which would be an immense gain over the “no treatment” plan which, according to a rational interpretation of Dr. Dickinson’s language, is the safest of the three referred to by him. From the three-hundred-page treatise before me, which is fresh from the mint (1881), and is a most valuable book for those who wish to study the pathology of the disease (Bright’s), but which is little calculated to aid any one healthward, except he be already pretty well informed in hygienic matters, I cull, in addition to the paragraphs already quoted, the following little nugget of pure gold: “We must avoid the use of any drugs which, under the name of stimulating diuretics, might exasperate the existing congestion; and we must enforce such diet as to reduce to a minimum that nitrogenous excess which finds its way out chiefly by the kidneys, and provides in many shapes effective means of irritation. Physiological repose is to be sought, not by debarring the gland of the harmless and necessary solvent, but by cutting off the materials of urea and uric acid.” How naturally, then, do we look for the continuing sentiments: “‘Spare diet and spring water clear’ may often be found sufficient though simple remedies. Of all diuretics water is the best.”[45] But how can we reconcile, with such counsel, the treatment that he himself commonly adopts? [45] Ibid., p. 86. The italics are my own, and I am amazed to find that this best diuretic is rarely the one used, and never fairly tested by this authority, who seems almost to exhaust the materia medica in the treatment of even infants of tender age. In one case noted by him, and in which, as he says, “the attack was slight,” and “the boy became convalescent,” but later, although under the doctor’s own eye at the hospital, with “no evidence of his having taken cold,” he became worse, went on to a fatal termination, “the urine becoming loaded with albumen and abounding with fibrinous casts—convulsive attacks—death!” It seems to me easy enough, however, to reconcile the unfavorable turn and the fatal termination with the treatment he adopted, viz., digitalis instead of “the best diuretic” (water); “fluid diet,” consisting chiefly of beef-tea—a non-nutritive fluid whose solid constituents are mainly urea, kreatine, kreatinine, isoline, and decomposed hÆmatine, exactly the animal constituents of the urine, except that there is but a trace of urea.[46] As the little fellow grew worse, “a little brandy was given to counteract the depressing effect of the digitalis.” “On the 27th, the pulse had fallen to 52, and was not quite regular; the brandy was therefore increased to two ounces daily,” with digitalis every six hours; later, a “diuretic draught composed of scoparium, acetate of potash, and nitric ether; on the 29th, this diuretic mixture was changed by the addition of nitre and squills; on the 30th, as was anticipated, he was seized with eliptiform convulsions, a succession of which came on, accompanied with foaming and biting of the tongue, and caused his death in two hours and a half.”[47] The next case reported was that of a child eighteen months old, treated at the hospital by the same physician, and described: “Dropsy—persistent diarrhoea—peritonitis—death.” “The child,” says the celebrated practitioner and author, “was frequently fed with pounded meat and milk; a little brandy was given, and opiates and astringents were prescribed to check the diarrhoea.” As he went on to his fate, he was made to swallow the following remedies: “opium, dilute sulphuric acid, tincture of the sesquioxide of iron, acetate of lead. The quantity of brandy was increased to three ounces daily. The child became paler and had a sunken look,” etc. “The child sunk a week after admission.” I make mention of these cases for the reason that up to this day the same horrible treatment is being practiced. Although these, and many even worse cases contained in this new work, transpired some years ago and were recorded in the first edition, still they remain in the new edition unaccompanied by any note of warning; and young or old medical students pore over and imitate the examples here set before them. I quote another paragraph from the treatise of Dr. Dickinson, which, if it has, as would seem evident, thrown little light about the doctor’s own pathway, as regards the appropriate treatment of the disorder, will prove instructive to some of my readers, and bear favorably upon my theory of disease. In the early pages (p. 29) of the treatise, Dr. Dickinson says: “It may be generally stated that this inflammatory disease arises from unnatural stimulation of the kidneys. The blood is charged with [food] material excessive in quantity or unnatural in quality, which these glands take upon themselves to remove. Their own proper elements of secretion are poured upon them in sudden and excessive amount, or matter is thrown upon them which is foreign to their usual habit. As a consequence of overwork, or of work to which they are not adapted, they take on a turbulent and abnormal activity. They become congested, the tubes get choked up with epithelial growth, and the disease is established.” Many of the symptoms in the following list are more or less frequently, some of them invariably, present in the case of supposably healthy infants, and are commonly considered as entirely normal. Fairly considered, however, they are the effects of excess in diet. To the greatest possible extent the superfluous water contained in their gross diet passes off by the kidneys, causing immediately a diseased condition of those organs from overwork; the cellular tissue becomes loaded and distended with the fatty matters, and also with much water, unrecognized as dropsy until it reaches immense proportions; what really amounts to purging is so universal as to be regarded as the normal state of an infant’s bowels, and this is, sooner or later, often very early, succeeded by the reaction termed constipation. The back-aching that results from all this is none the less terrible because the little sufferers can not talk and tell where the pain is; peevishness, general malaise, and crying, tell of suffering, not of (their) perversity. Among the SYMPTOMS OF KIDNEY DISEASE are the following: frequent and copious micturition (wetting the bed or getting up at night); later the excretion of urine is scant, passed frequently, or, may be, suppressed altogether. Fat; later—emaciation. Heat and dull pain in the loins[48] (small of the back), increased by pressure; slight or considerable “puffing” about the eyes, noticeable only at times, or it may be constant and unrecognized as a symptom of disease; it may be diminished at times, as the secretion of urine becomes modified, or the condition of the system happens, temporarily, to improve. And it increases often when the secretion of urine diminishes, or is passed less freely. The countenance is more or less pallid, and may have a brownish tinge. Croupy breathing accompanies oedema of the larynx. “With children, inflammation of one or other of the organs of respiration is the most fatal tendency of the disease. Not only are they liable to pleurisy, pneumonia, and bronchitis, but, also, to membranous croup.” Constant tendency to irritability of manner, easily angered, unreasonableness, petulance; with infants—constant fretting, crying, nothing will interest or amuse them. Diphtheria is, I believe, only a phase of albuminuria. Says Dr. Grasmuck, treating of diphtheria, and other physicians have observed the fact: “Another peculiarity of the scourge is its fondness for children of a certain condition—the fat, sleek, soft, tender, ‘well-fed’ children so generally admired—such children can offer but slight resistance to this disease; being, in fact, chronically diseased, they are predisposed to ‘attacks’ of all kinds; and, living to adult age, furnish the greater proportion of cases of tuberculous disease. On the other hand,” he continues, “I do not know of a single instance where the disease proved fatal to—rarely attacking—a child of the genus ‘Street Arab’—children who spend most of their time out of doors, are thinly clad, sleep in cold rooms, have a spare diet, and who have no one to pamper them unwisely.” Dr. Dickinson treats of albuminuria under three heads, viz., tubular nephritis, granular degeneration, and lardaceous disease. He designates, also, such other diseases as are likely to result in consequence of this disorder; and finds some of these peculiar to, or more apt to afflict, sufferers from one or the other forms. He says: “It is seen (from the table presented) that nephritis is a disease of infancy and youth, causing most deaths in the first decade coincidentally with the prevalence of scarlatina; many in the third when the toils and exposures of active life are perhaps the most prolific of evil. Granular degeneration belongs to middle and advancing life, and is most fatal between fifty and sixty. The one flourishes upon the febrile accidents [!] of childhood and the susceptibilities of youth; the other develops when the habits of life begin to tell and the effects of old age begin to appear. The lardaceous disorder has little to do with either extreme of the mortal course; it is chiefly associated with the vices of early maturity, and with tubercle and struma, disorders more incident to the young than the old, and in their suppurative form to youth rather than childhood.” Among the diseases resulting, or likely to result, from one or other forms of the disease, Dr. Dickinson names the following: dropsy, pneumonia, pleurisy, peritonitis, bronchitis [before mentioned]; pericarditis, endocarditis, hypertrophy of the heart, with cardio-vascular thickening, [heart “diseases”]; hemorrhagic accidents [bursting of blood-vessels—apoplexy] depending as they do upon structural changes of the vessels; diarrhoea. SOME OTHER SYMPTOMS. Nasal catarrh; the radical suppression of this discharge is likely to be followed by serious if not fatal kidney disease.[49] (To remove the former by removing its cause, thus rendering the discharge unnecessary, is quite another thing). Hence the danger of using so-called catarrh remedies, or of adopting any specific local treatment: they are either inert or injurious.
Erysipelatous inflammation of the dropsical limbs; “vomiting may happen at any stage, even the earliest; it is often incontrollable.” Head symptoms, which occur in the more prolonged forms of the complaint, are usually of a convulsive kind, whereas, in acute cases, coma is apt to set in without any such prelude. Epileptic seizures may be preceded by pain in the head, drowsiness, or peculiarity of manner, or may occur without any premonitory sign. Says Dr. Dickinson: “The gouty habit, from whatever circumstance it arise, is one of the more obvious and immediate conditions to which granular disease of the kidneys can be traced.” ... “The disease is a frequent result of gout; this is by far the most important fact in its etiology. It is one of the results of the gouty diathesis (see Rheumatism), and may precede or follow the external manifestations.... It is scarcely necessary to insist ... that the gouty condition comes first.” The fact is that there is a process of degeneration going on throughout the entire structure of the man, even to the last tissue, and the symptoms are all indicative of this; and this is more or less strictly true of all disorders. The naming and classifying of “diseases” is calculated to mystify and mislead: sickness is the proper term for describing them all; self-abuse, in the broadest sense of the word, is the cause of them; and obedience to law, the only means of prevention or cure. I hold that the gouty, the rheumatic, the strumous, the “colds,” and all other diatheses, are practically unimportant distinctions. The technical difference is, of course, well understood and admitted. In any event, it is certain that the course of living best suited to prevent one, is also best adapted to prevent or remove all. For all practical purposes, however, they may be classed together; and whoever desires, either for themselves or their children, exemption from, or the alleviation of, suffering, have only to adopt a pure mode of living in order to escape, or emerge from, the disease diathesis.
NOTE.—The limits of this work forbid an extended consideration of the influence of this or that occupation in promoting this disease; nor is it, in my estimation, essential. The trades must go on, regardless of their influence upon health. There must, for example, be painters, plumbers, compositors, tin-workers, etc., even though the absorption of lead does tend to produce the gouty condition and, so, a predisposition to renal disease. A sufficient degree of care in other directions would enable this class to outlive the more favored ones who neglect the laws of life. See note 2 in Appendix, p. 276.
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