§ 229. Nephritis, inflammation of the kidneys.

We distinguish nephritis, or inflammation of the parenchyma; pyelitis, or inflammation of the mucous membrane of the tubes and pelvis of the kidneys; and perinephritis, or inflammation of the capsule. These different varieties bear a close resemblance to each other; we shall therefore condense their symptoms in one group.

One or both kidneys may be inflamed at the same time. The patient complains of an acute or dull pain in one or both loins, frequently extending over the whole lumbar region; it is aggravated by pressure, motion, bending forward, deep breathing, coughing, sneezing, urging to stool, lying on the affected side, and warmth of the bed. The pain extends along the ureters down to the bladder, and the testicle of the affected side is spasmodically drawn up; in females the pain strikes into the round ligaments. Sometimes the inflammation is attended with vomiting, nausea, retching, cardialgia, colicky pains; the region of the kidneys is hot, painful, bloated, and the patient is unable to lie on the affected side; if both kidneys should be affected, the patient has to lie on his back. In some cases the secretion of urine is either diminished or suppressed, or the emission of urine is attended with pain and burning; the urine has a fiery-red appearance, and is sometimes sanguineous or mixed with pus. In most cases the thigh of the affected side is numb, there is great anguish and restlessness, constipation, and other secondary affections supervene. The disease generally sets in with a hard chill, which frequently occurs simultaneously with the pain in the kidneys: the skin then becomes hot and dry; the pulse is full, hard, and tight, sometimes contracted. The fever sometimes becomes typhoid, in which case sopor sets in, the patient lies immovable on his back, his answers are incomplete, the tongue becomes dry and black, the pulse small and frequent.

§ 230. Nephritis principally befalls full-grown people. In young, plethoric subjects, it is disposed to terminate in suppuration. In this case, the pains become dull and aching, and the patient complains more, and more of heaviness in the region of the kidneys; in the most fortunate event, the pus is discharged with the urine.

Complete suppression of the urine, typhoid and putrid symptoms, delirium, sopor, violent vomiting, hiccough, great anguish and restlessness, coldness of the extremities, repeated chills, are unfavourable symptoms. The simultaneous presence of inflammation of other organs, renders the prognosis still more doubtful.

§ 231. The best remedies for nephritis are: Can-tharides, Cannabis, Nux vom., Belladonna, Aconite. Pul-sat., Hepar. sulph., Merc, Sulphur, Thuja, Cocculus, Colchicum.

The treatment depends a good deal upon the cause of the disease. If the disease should have been caused by suppressed hemorrhage, or by abuse of spirituous drinks, Nux vom. will be found the best remedy, when the disease is characterized by tension, distention, pressure, heat, burning in the lumbar and renal region. Nux is likewise suitable for nephritis generally, provided the symptoms correspond; or for nephritis occasioned by gravel or suppression of the piles.

The causes just named, particularly suppressed, scanty, or delayed catamenia, point likewise to Pulsatilla, especially in patients with slender forms and irritable dispositions.

Belladonna, and in some cases, Hepar sulphuris, is indicated by the following symptoms: Stinging-burning pain in the region of the lumbar vertebrae, close to the spine, extending along the ureters down to the bladder, and recurring periodically with increased violence; it sometimes involves the abdomen below the umbilicus, and is aggravated by contact; colicky pains and cardialgia, heat and bloatedness in the region of the kidneys, a fiery urine, which is passed in small quantities; anguish and restlessness, constipation, etc., are likewise present.

One of the principal remedies for nephritis is Can-tharides, particularly when sticking, tearing, and cutting pains in the lumbar and renal regions are present, the pains being aggravated by the least motion, setting in in paroxysms, and thereby suddenly interrupting the breathing; the emission of urine is very painful and frequently impossible, or the urine is passed in drops with intolerable burning pains, mixed with blood. The fever is violent, the pulse frequent, full, rather hard; the thirst is great, the cheeks hot and red; loss of appetite; constipation; sleep is impeded by the violent pains and the urging to urinate, which is always greater at night; the patient always feels worse in the morning.

Cannabis is indicated by a drawing, ulcerative pain from the renal region to the groin, attended with anxiety and a qualmish sensation.

Cocculus, Mercur., Plumbum, Thuja and Colocynth, are likewise useful in affections of the kidneys.