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A--Movable or Floating Kidney
B--Hematuria
C--Albuminuria
D--Pyuria
E--Uremia
F--Acute Bright's Disease
G--Chronie Bright's Disease
H--Nephrolithiasis
I--Tumors of the Kidneys

   Description.--The kidney is held in position by the peritoneum and fatty capsule, the former passing in front of it, and by the blood vessels. Normally the fixation is firm; but when the constitution is enervated, the general muscular system relaxed, ligaments all expressionless, then it is that any and all of the organs have a tendency to gravitate below their normal position, the same as the muscles of the arms, legs, and other parts of the body. If the tonicity is lost--enervated energy below par--they become expressionless. The muscles of the face sag; the tissues on the neck drop down. When there is an accumulation of fat--a large and heavy omentum--or when the bowels are distended a great deal with gas, and constipation is marked by a continuous accumulation, all these intra-abdominal, abnormal conditions have a tendency to drag the kidneys down. In these days of superfluous surgery, there is no attempt made to overcome the sagging tissue other than by operation. It is an excuse for professional laziness. It excuses the profession from thinking out the real cause and then adopting a proper treatment.

   Symptoms.--There are no symptoms. All the symptoms that cause physicians to explore the abdomen, in palpating to discover either a pus tube or a derangement that will account for the patient's complaint, may be caused by constipation, impaction of the bowels, colitis, chronic appendicitis, indigestion with distention from gas. Certainly there is no symptom that can be positively identified as that of a floating or dislocated kidney. There has been nearly as much professional insanity on the subject of floating kidney as on appendicitis, ovaritis, and ptosis of the various sections of the alimentary canal, because it is often mistaken for constipation. The chief motive actuating the profession in making a diagnosis is to find an excuse for an operation, rather than to find the cause of these various comfort-destroying conditions that have been brought on from bad habits of eating and neglect of the bowels.

   Treatment.-Treat the patient for what is really the disease. His life should be corrected; his eating should be looked after. The tendency for the generation of gas must be overcome. Constipation certainly is to be got rid of. Colitis must be treated as general catarrh must be treated; in fact, the treatment for general catarrh will correct the colitis. If there is dilation of the stomach, or sagging of the transverse colon, all these conditions can be overcome by proper feeding, proper care of the body, and proper exercise.

   With any of these conditions named, including the subject of this chapter, there must be systematic exercise practiced daily. The tensing exercises should be used fully thirty minutes twice a day.

   Should the kidney be removed? I have never seen a case that required it. Some cases may require a pad and a bandage to give temporary relief; yet I think that it is not a good thing to educate the patient into crutches, so to speak--something to support. The muscles should be made to support the body. This can be done by exercising enough to bring them back to a normal tone.

   This symptom may, for convenience, be divided into constitutional derangement, and functional and organic derangement, of the kidney.

   The hemorrhage from the kidneys coming from the constitutional derangement is that of cancer. Cancer will not develop in the organism without a preparatory derangement running on for several years; and when cancer is once established in the kidneys, or any other organ, there is no cure. If it is established in one of the kidneys, and the kidney is removed, the constitutional derangement will cause the other kidney to be affected; or, if not the kidney, then the disease will start up in some other part of the body.

   The specific diseases will sometimes cause hemorrhage. Inflammation and congestion, as in Bright's disease, will produce hemorrhage. Inhalations of turpentine have been known to bring on bleeding. Strong drugs, such as are sometimes given for venereal diseases, have been known to produce hemorrhage. Stone in the kidneys, or injuries, will produce bleeding. The passage of the stone through the ureters will cause hemorrhage; and when the stone has passed, if there are any more formed in the kidneys, the hemorrhage that came from the expulsion of the one will pass away, never to return. A continuous hemorrhage from the kidneys is very apt to cause a physician to suspect cancer.

   Diagnosis.--Blood in the urine, when it comes from the kidneys, will be smoky at times; at other times bright red. Sometimes it will have a color like rich wine. Examination with the microscope will clear the question of whether it is blood that causes the urine to be discolored. It is necessary to know whether the blood comes from the bladder or from the kidneys. When the blood comes at the end of micturation, it indicates that the bleeding is from the bladder. Where the urine is bloody from the start, it may be due to granulations in the urethra; or the blood may come from the kidneys, because, when the urine comes down through the ureters, it becomes thoroughly mixed with blood when there is hemorrhage from the kidneys; hence all the urine from the bladder will be mixed with blood; whereas, if there is simply hemorrhage from the bladder, it will be the last to pass--or, rather, it will pass at the end of micturation. Sometimes it is a little hard to tell the difference between a hemorrhage from the kidneys and a hemorrhage from the urethra. As a rule, sounding the urethra will clear the matter up; for the sound will discover stricture or granulations which have become giant in size and very hemorrhagic. This trouble is very easily cured, whereas hemorrhage of the kidney is questionable. Time should be given in all these affections; for a cure often follows a wise letting-alone.

   Treatment.--It matters not what the cause of hemorrhage of the kidneys is, patients must be kept quiet, and they should eat very little; or, what would be better, a fast should be taken. If the hemorrhage comes from a simple injury, from a stone, or from the extension of specific disease, resting in bed and fasting will clear up the symptoms more quickly than anything else.

   Break the fast on buttermilk as soon as the symptoms are all relieved. After that the patient may have a pint of buttermilk three times a day for a week. Then, if all is going well, the buttermilk is to be continued, and a little fruit added morning, noon, and night, for the second week. For the third week, fruit and buttermilk morning and night, and at noon toasted bread, a combination salad, and two vegetables.

   This may come from many causes. Without constitutional symptoms, attention should be given to the urethra and bladder. A catarrhal condition of the bladder will continue to furnish albumin in the urine for months and years. Stricture, with granulations, in the urethra will present more or less albumin in the urine. At times it will be clear, at others there will be albumin. Onanism will create such a seminal weakness that the seminal fluid will be passing almost daily with the urine. This is the disease known as spermatorrhea. This will cause an albuminous reaction to the test given the urine. Then again there are those who eat very heartily, crowding their nutrition and circulation, and who show a certain amount of albumin passing off at times--two or three hours after eating. The albumin in these cases will be rather irregularly present in the urine; but unless the cause is discovered, and the patient made to believe that there is liable to be something seriously wrong, he may develop Bright's disease, which is unnecessary.

   Treatment.--Where there is a cystitis, either catarrhal or gonorrheal, the treatment must be in keeping with the cause. If the urine is rather offensive, it would indicate that a food is the cause of the odor, or that the urine is retained too long in the bladder. Possibly the bladder trouble may come from stricture of the urethra, or from inflammation of the neck of the bladder. Sounding the urethra into the bladder will clear this passage and develop whether there is stricture or not. After using the sound, the catheter should be introduced and the bladder washed out. The bladder-washing should be repeated once every day. Perhaps the evening before bedtime is the best time.

   Of course, the patient should be given very little food--perhaps fruit, or simply buttermilk. Buttermilk acts better than anything else on all kidney and urethral derangements when it is desirable to increase the flow of urine. If there is a strictured condition of the urethra, this must be overcome by gradual dilation. If the albumin comes from seminal weakness, the patient must be instructed and made to understand just how much he is injuring himself. He will be requested to stop his self-abuse. If he will not, there is no use of attempting to cure him; for it cannot be done so long as the practice is continued. Those who overeat must be informed of the danger there is in keeping up so much pressure on the kidneys. They can be assured that if they do not let up they will certainly in time bring on disease of the kidneys.

   Etiology.--This symptom may come from many causes--possibly abscess in the kidney, abscess in the pelvic region emptying into the bladder, ulceration of the urethra, or chronic specific inflammation of the bladder. Pus may burrow into the bladder and may force internal abscess. The common cause of chronic urethritis is gonorrhea. I had one case of post-gonorrheal infection where there was as much as two ounces of pus passed with the urine each twenty-four hours. The case had been diagnosed abscess of the kidney, and an operation for the removal of a kidney recommended; but my diagnosis was gonorrheal infection of the spermatic vessels. It was my opinion that the patient would get well if he would take the proper care of himself--which he did. Five years afterward he was free of the symptom of pus in the urine.

   Treatment.--The treatment for such cases must, of course, be in keeping with the diagnosis. An abscess located contiguous to, and emptying into, the bladder must be located and drained properly. Chronic urethritis must be treated by sounds, diet, etc. The dieting must be governed by the condition of the individual. If he is stout and rather full-blooded, he should be fasted. If only in medium flesh, he should eat fruit morning, noon, and night. He may gradually increase the amount of food by taking starch and meat until a full diet is taken on. It may take one, two, or three months to get to a full diet. If there is chronic inflammation of the bladder, it must be treated by irrigation.

   This is a form of toxemia--retention of the urine in the blood--caused by faulty elimination. The exact "modus operandi" has not been discovered. Probably the cause is overworked kidneys, enervation, or faulty metabolic changes-faulty nutrition.

   Symptoms.--We are inclined to recognize an attack of uremia as indicating an inflammatory derangement of the kidneys. Where the poisoning is set up in pregnant women at the close of gestation, it is safe to decide that there is a faulty elimination by way of the kidneys; yet, when there is nothing extraordinary taking place--such as overeating, overstraining, overworking, worrying, anxiety, etc.--the kidneys do their work very well. When this can be known, the individual should be warned about being extra careful of himself, and he may run on for years without developing kidney disease. The kidneys may be weak, the same as all other organs. When this state exists, gluttony will certainly bring on overworked kidneys, and as a result there will be uremic headache. Unless the cause is understood and removed, uremia of a very pronounced character is liable to develop at almost any time.

   Cerebral symptoms are met with in uremic poisoning. Crimes have been committed, and the victims punished, without anyone being aware of the fact that it came from uremic poisoning. Short seasons of insanity have been known to be caused by uremia, and the patient has recovered and passed along for years, and perhaps for life, without a repetition. People who are troubled with delusions should have the urine examined.

   Convulsions in children and in grown people are brought on from uremia. Epilepsy is quite a common result of urine in the blood. Unconsciousness accompanies general convulsions. Uremia often causes gastro-intestinal symptoms, such as vomiting. Where the vomiting persists, death follows from exhaustion. The probabilities are that in such cases there is either cancer or sclerosis of the kidneys. Where the tongue is very foul, and the breath heavy and fetid, with a swollen state of the mucous membrane of the lips and gums, with ptyalism, or copious flow of saliva, uremia may be suspected. Chronic cases of uremia often end in acute diseases, such as peritonitis, pleurisy, meningitis, and inflammation of the pericardium.

   Uremia may be mistaken for brain diseases, such as hemorrhages, meningitis, and even tumors. The uremic headaches are very much inclined to cause the physician to think of brain tumors; for they are so persistent and resistant to treatment that either brain lesions or tumors are thought of. When a patient is found under the influence of uremic coma, it may be suspected that it is a case of alcoholism. It is very easy to determine whether this is true; for, if it is alcohol poisoning, the breath will give off a strong odor of alcohol.

   Definition.--Inflammation of the kidneys of a diffusive character; that is, the inflammation is of the parenchymatous (external) tissue or substance, not of the interstitial (substance of gland itself).

   Etiology.--Anything that will cause inflammation of any other organ of the body will cause inflammation of the kidneys, provided the kidneys are susceptible to the exciting influence. The different organs of the body are not alike susceptible. There is a predisposition on the part of some families to take on lung diseases, of others to take on Bright's disease, and so on. Then, when the individual lives in such a manner as to break down his resistance, and loads the blood with toxins, catarrh or inflammation of different parts of the body is liable to be set up. And of course, whichever organ has the least resistance is the organ that will be the seat of the toxin inflammation. Those who are toxin-poisoned are susceptible to catching cold. After the toxemia is once established, a cold will be the last straw, and an inflammation starts up in the kidneys. We may say that toxins in the blood poison the kidneys. We may say exactly the same thing about the heart, lungs, and liver. When one has a clear comprehension of how man deranges his body, it becomes an easy matter to understand affections of the different organs of the body. When these organs are weakened from toxic infection, they are very susceptible to such drugs as atropine, cantharids, potash, carbolic acid, etc. Alcohol is an irritant after the kidneys have once become diseased.

   Morbid Anatomy.--The kidneys are larger and less firm, and have a chocolate color, with here and there white points. The surface, when stripped of its investing membrane, is pale, sometimes mottled.

   Symptoms.--The disease comes on suddenly, the same as a cold settling anywhere in the body. Sometimes there will be a swollen condition of the ankles, showing a dropsical effusion. When the disease is established, the patient becomes pale, and there is a puffiness underneath the eyes; perhaps also puffiness of the toes, and just above the toes on the feet. This will grow if the shoes happen to be loose. There will always be a ridge just above the shoe tops. In progressive cases the dropsical effusion increases until all parts of the body are dropsical. There is pain in the back, and nausea and vomiting may be present. Where there is much uremia there will be nausea and vomiting. The temperature varies, sometimes being almost down to normal, and then rising to 103° F. The urine must be examined, and it is necessary to keep track of the amount passed. At first there may be suppression. Where there is, there may be intense headache, passing into coma, or convulsions followed by coma. There may be blood in the urine--certainly always albumin and tube-casts. Sometimes the quantity of urine is reduced to four or five ounces in twenty-four hours. Its specific gravity will range from 1.020 to 1.030. The color varies from a brown or gray to a deep wine color. Sometimes, in children, it will be a bright red. Anemia is an early symptom in this disease. Effusion sometimes takes place in the different cavities of the body--in the pleural cavity or the abdominal cavity--and the lungs sometimes become edematous.

   Diagnosis.--Sometimes the very worst cases of Bright's disease have little to announce their presence, except the puffiness of the feet and legs; and this may come and go. Such cases will often get up of a morning with one side of the face puffed. The side that has been on the pillow will show the creases in the pillow, and there will be a bloating of the tissues. The general health will not seem to be impaired very much. It is safe to examine the urine in all cases where there is a tendency for puffiness of the feet and legs or around the eyes. In fact, where there is any feeling of discomfort, requiring the patient to consult a physician, the prudent physician will always examine the urine. If there is nothing in it, it requires only a little time to decide the question, and then there is no doubt in the mind about the true state of the kidneys. Without examining the urine, no one can tell anything about whether or not the kidneys are affected. Sometimes the first symptom that will present itself, in cases of advanced Bright's disease, is that the patient is taken with convulsions. Then again there will be no convulsions in a case advanced almost to a fatal termination. Where nephritis comes from scarlet fever, symptoms are marked, and the prognosis is doubtful unless the symptoms are detected quite early and proper treatment is established. Cases have been reported of Bright's disease with anasarca (dropsy of the abdomen).

   Treatment.--Where children show a dropsical effusion and scanty urine, following soon after a scarlet fever or a rash that is partly suppressed, they must be treated vigorously at once. Hot baths every three hours for the first day or two, then three times a day, and then once a day on going to bed. No food for the first forty-eight hours; then an orange for breakfast, buttermilk for dinner, and grapefruit for the evening meal. No further eating is to be encouraged until the symptoms are thoroughly under control.

   All patients with kidney disease should be put to bed. The feet must be kept warm by putting artificial heat to them, and a fast should be required of sufficient duration to overcome the dropsical effusion in the extremities and the different cavities. They should be given all the water they wish to drink, if there is no constipation; if there is, no water is to be drunk. After the symptoms are well under control, then buttermilk may be given for one week--a pint morning, noon, and night; for a child a glassful, and for an adult a pint. As the symptoms improve, increase the amount. Grapefruit and oranges can be given with the pint of milk for the adult at each meal, instead of increasing the amount of milk. It is not necessary to give any fluid except the fruit juice, to cause kidneys to act. If the weather is warm, melons may be taken for one meal a day--all the melon desired may be eaten. This fruit has a tendency to stimulate an extra amount of urination. The bowels must be kept open, and there should be a movement every other day. If necessary, put a small enema into the bowels--a pint of water. Allow it to remain there for ten to twenty minutes, and then try to have a movement from the bowels. If this is used every other night, it probably will overcome any tendency for constipation.

   This disease is no different from acute Bright's disease, except that the patient has shown a strong resistance, and has also been incorrigible, inasmuch as when better he has been imprudent. Those who have once had an attack of Bright's disease, and were fortunate enough to overcome it, should be very willing to live moderately and take the proper care of themselves. Many people die of Bright's disease because they prefer a short and merry life, to a longer one if subjected to what they call restrictions and privations.

   Symptoms.--Acute nephritis has been showing itself occasionally for some time--perhaps slight attacks a few months apart. The chronic form may start up in a very insidious way, following badly treated acute fevers, indigestion, or a general breaking-down from any cause. A patient will have a period of depression, followed by swelling of feet and ankles. There are usually pallor and puffiness about the eyelids. The feet become more and more swollen of an evening, and later of a morning. This is not true in the swelling that follows a weakened condition of the system from overwork; for then the feet are swollen at night, and there is no swelling at all in the morning. The urine is usually scanty and has a yellowish, cloudy appearance. On account of the urates, it is usually cloudy. On standing, a sediment settles to the bottom. When the urine is heated to the boiling-point, the cloudiness will increase. Then, by adding a drop or two of lemon juice or two or three drops of acid, the phosphates will clear. If there is albumin in the urine, it will not clear. A very ugly-appearing urine is passed by patients who have a great deal of uric acid in the system and who pass large quantities of phosphates and urates. The urine will look very heavy, and there will be red, sandy particles settling to the bottom. Often this urine will clear up as nicely as any urine can by simply warming it. This indicates that the patient is eating altogether too much of the staple foods, and not enough of the fruits and vegetables. A day or two on fruit will clear such urine. Perhaps one meal of fruit will do so. But in Bright's disease the urine, when heated, will coagulate, so to speak. Where there is a great deal of albumin in the urine, it will congeal to such an extent that it cannot be poured out of the test-tube. Such cases as this are very rare, however. When acid is added to albuminous urine, the albumin is not cleared up; it remains as the heat has left it.

   The specific gravity of the urine in the early stages is from 1.020 to 1.025, sometimes even going as high as 1.040. In the last stages the specific gravity is low. The quantity is always reduced. One of the most pronounced symptoms of Bright's disease is drowsiness.

   Treatment.--The treatment need not be any different from that recommended for acute Bright's disease.

   Symptoms.--The patient may pass gravel for years. I remember a case I had that in the course of five years passed a two-ounce bottle of small stones, the largest being not larger than an ordinary pea, and most of them half that size. Renal colic is common in this disease. The cause of it is passing of a small stone through the ureter. Great distress is complained of. Pain extends from the groin to the kidney, and sometimes down the spermatic cord to the testes. In cases where the stone is in the kidney, there will be no other feeling of discomfort. The patient has difficulty in telling just where the pain is. If asked to put the finger on the spot, he will start to feel with his hand, and unconsciously he will pass his hand over the entire region of the kidney down to the pelvic bones in front, and, to end his efforts of description, he will acknowledge that he cannot find the spot, the reason being that there is no location-the pain is reflex and not stable. The physician must distinguish between stone in the kidney, appendicitis, neuralgia of the spermatic cord, ovaritis, constipation, and colitis. Indeed, there may be a feeling of weight in the reproductive organs, and the patient should be examined for stricture of the urethra or rectum, before diagnosis is made, or an opinion settled upon in regard to the real cause of the discomfort.

   Treatment.--The patient's diet must be corrected. It is a case of lithemic diathesis, or what is known as the gouty diathesis, and the style of living has been unsuited to the requirements. The patient has been taking altogether too much mineral-bearing foods into his system, and has not taken enough of the eliminating foods. It is doubtful if such diseases as renal colic, gall-stone, or stone in the urinary bladder will ever develop if the dietary is well balanced, carrying enough raw vegetables and fruit to prevent the accumulation of mineral in the system. It should not be forgotten, however, that worry and overworked emotions, and the use of stimulants, will cause the disease.

   Tumors of the kidney are of two kinds--malignant and benign. Sarcoma is the most common of the malignant diseases to take hold of the kidney.

   Symptoms.--Blood in the urine. Blood sometimes is passed in clots, and often molds of the pelvis of the kidney have been passed from the bladder. Cases go almost to a fatal termination without great pain. Perhaps a decided discomfort is felt at times in the small of the back. The pain will sometimes radiate down through the course of the ureters, resembling somewhat the pain of stone in the kidney. There will be a continual loss of flesh. In some cases it will be very rapid. There is no cure. If the case can be benefited at all, it must be done by a proper dietary and proper care of the body.

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