– Some personal observations in the treatment of chronic interstitial nephritis (E. A. Simonds)

chronicinterstitialnephritis Some personal observations in the Homeopathic treatment of chronic interstitial nephritis

“Among the better classes of this country,” says Osler, “chronic Bright’s disease is very common, and I believe is caused more from overfeeding than overdrinking.” This form of kidney lesion, I am led to believe, is very often overlooked from the fact that albumen is rarely present in the urine, at least in quantities that the general practitioner will detect. (You will bear in mind, please, that the writer is not a specialist.) Dropsy, even puffiness of the eyelids, is seldom seen, but the fact remains that the kidneys may reach an advanced state of disease without presenting symptoms that will deprive the patient of the ability to work, and pursue his usual vocation. Indeed, the first intimation that the patient may have of disease, may be an apoplectic seizure, or a uraemic convulsion; but this is not usually the case, as there is frequently a history of chronic headache, digestive disturbance, difficult breathing, palpitation, insomnia, pain in the loins, haemorrhage, etc.; indeed, the symptoms of this disease are so complex that one has to be continually on his guard, as I do not know of any single symptom, or group of symptoms that calls our attention distinctively to this disease, unless it be chronic headache, insomnia, or anaemia. But we cannot get away from physical conditions in disease more than in anything else, and I am glad to be able to say that we do not have to depend entirely on symptoms in this disease, but the changes in the heart and arteries are so plain and clearly marked that we need not err in any well developed case. I wish to emphasize this, and shall likely repeat it until it becomes wearisome, i. e., increased arterial tension, accentuation of the second sound of the heart over the sternum, and the apex beat heard loudest even, or beyond the nipple line to the left.
 At the risk of being thought to deal with elemental subjects let me say a word here on taking the pulse. We should be careful not to confound the noncompressible artery of arteriosclerosis, which feels like a whip cord beneath the examining finger, with arterial tension, which may also be noncompressible. The pulse may also seem weak and almost imperceptible, yet when measured by the sphygmomanometer shows a high degree of arterial tension. Not all of us possess, or know how to use the above named instrument, but for all practical purposes we possess in the trained fingers an instrument that serves us well.
 Let us approach our patient with our right hand. We take, say the left of the patient with our index and middle fingers on the radial artery. We make firm pressure with our middle finger upon the artery, while the index finger feels lightly for the pulse beyond, towards the distal extremity. If arterial tension exists the pulse can still be felt with the index finger in spite of pretty firm pressure above. When arterial tension exists our next thought should be of the heart. The apex beat should be searched for and located. It should be felt and heard strongest and loudest midway between the nipple and the point of the breast bone. In interstitial nephritis it will be heard loudest even with, or to the left of the nipple line, and farther down. The second sound at the aortic cartilage will be heard to close with a sharp, loud click almost bell like, in advanced cases. These conditions are sufficient, I believe, to justify a diagnosis of interstitial nephritis, at least they furnish us with a good working diagnosis, as the following case will illustrate:
 Mrs. B. Age 62. Mother of a large family; had had them home for a Thanksgiving dinner, of which she partook heartily. The following morning, while dressing her hair, she fell over in a convulsion, and lay unconscious until the next day. I saw her in the afternoon following the attack, with two other physicians who were in attendance. The characteristic pulse and heart changes were present, and I said chronic Bright’s. The attending physician said he had made repeated examinations of the urine, and in fact had already catheterized and examined a sample, and both agreed that no albumen was present. They acknowledged, however, that it was profuse, with low specific gravity – 1008, as I remember. Farther inquiry revealed the life history of headache and progressive emaciation, and anaemia. We immediately put her upon the treatment that I shall later detail, and she recovered, and has been comparatively well ever since. The headaches which she had had for thirty or more years entirely cured.
 Haemorrhages into the retina are common, and patients consulting us for eye troubles will show the characteristic pulse and heart changes. Of course, I do not advocate jumping at conclusions, but we will, by following up the thread, for its natural sequence most always find that these patients have to rise once or more at night to void urine. That the quantity is increased to 60 or 70 ounces, that the urine is of a low specific gravity – ranging between 1002 and 1006, forgetfulness and mental inactivity are noticeable. Headache is a very common symptom, so also anaemia. The following case that has been under my care for the past ten years will illustrate especially the family tendency:
 Mrs. F., age 70, had lost four brothers with Bright’s disease when she was taken ill ten years ago. Had always been subject to bilious attacks, and “bilious headaches.” They became more severe in the spring and finally became almost continuous. So severe as to prevent sleep. A sharp, lancinating pain in one or the other temple, but most severe and persistent in the bone behind the ears. The pain was so severe that the patient, from lack of rest, grew thin. The anaemia was profound, and in spite of a summer spent at the Thousand Islands, with the best medical attendance attainable, she grew steadily worse, and took to her bed from which she did not arise in ten months, requiring the constant attendance of a day and night nurse. During this time she lapsed into a state of unconsciousness three times, which lasted three, two, and one days, respectively. The case was diagnosed, everything from pernicious anaemia to pachymeningitis. In this case were the characteristic heart changes with high arterial tension, although the pulse reached 120 to 140 and could scarcely be counted.
 Osler says that the disease in question is an insidious disease dependent on renal changes that can no more be cured than wrinkles or gray hairs, but this woman has had ten years of life comfortable in the main, and is as hearty and sprightly a lady of seventy as one will often see. She goes to Florida every winter, stands the trip well from Northern New York, and has not taken much medicine for several years. This, I think, was the most unpromising case I ever saw recover, and if any person could be said to be “Called Back” it is she.
 Many a prospective mother has named her baby, and when it was born found the name would not fit. So I find myself in about that fix. The point I wish to make is the therapeutic and diagnostic value of Glonoine in these cases, and while it is not intended to write extensively on chronic interstitial nephritis, it is necessary to touch some of the high places in diagnostic importance, objectively and subjectively, as well as some other phases of the treatment.
 The causes of the enlargement of the left side of the heart and the arterial tension are matters in dispute. Osler says the heart enlarges to overcome the arterial tension; in other words, is conpensatory to meet the increased labor imposed upon it. Some hold, and I think, Carleton among them, that arterial tension is caused by the irritation produced by the presence of uric acid circulating in the blood, which the damaged kidney is unable to eliminate. The temptation is great to enter into pathology here, but I trust the discussion will bring that out. For myself, I accept the theory that the arterial tension is caused by the irritation produced by uric acid. There may be other causes that will produce high arterial tension, but for working purposes arterial tension should suggest chronic interstitial nephritis and should call attention to the second sound of the heart as heard over the sternum. A sharp accentuation of this should lead to the farther examination of the apex beat, which, if found displaced to the left, and downward, makes interstitial nephritis probable. The well known tolerance of these cases for Nitro-Glycerine has led me, as the next step, to administer a dose ranging from one-fiftieth to one one-hundredth of a grain and watch the effect. The person without high arterial tension who can take one one-hundredth of a grain of Nitro-glycerine without experiencing the physiological symptoms is very rare. After watching the effect of Nitro-glycerine for ten years, I am inclined to attach more importance to the tolerance of this drug than to the chemical examination of the urine, especially the presence or absence of albumen. To be sure, the examination as to quantity, 60 to 100 ounces – specific gravity – 1002 to 1016 – and especially the microscopic examination, should not be neglected. Carleton says that only by repeated microscopic examinations can the early diagnosis be made.
 The following case will illustrate the effect of Nitro-glycerine: Mr. W., a paper manufacturer, had been suffering from extreme dyspnoea for several days and unable to lie down. When I saw him he was sitting with head resting on the back of a chair, face covered with perspiration, breathing labored, and patient very much exhausted. The radial pulse showed a high degree of tension; the second sound over the aortic cartilage accentuated, with apex beat to the left of the nipple line. I suggested to the attending physician to give him a fiftieth of Glonoine hypodermically, which he did with none of the characteristic symptoms of the drug. In a short time the patient went to bed and slept soundly. He continued to take one full dose morning and night, which, in his case, was a fortieth of a grain. In a few days he was back in the mill, and has had no return of the trouble. This patient had been taking a De Costa tablet containing one one-hundredth of a grain, every six hours, by the mouth.
 If we accept, as a fact, that uric acid circulating in the blood is the cause of arterial tension, then it seems to me to be more or less mechanical, and the Glonoine should be kept up as long as the cause is operative, which in some cases is during life. It is surprising to see how quickly old chronic headaches, and, in fact, all symptoms due to arterial tension, will disappear under this drug. The old school gives us credit for first using this remedy, and if we never did anything else, it has justified our existence. Mercurius dulcis covers the anaemia and many of the symptoms, and I give it pretty continuously in a rather low trituration, the second or third decimal. Other remedies often indicated are Kali iod. and Ferrum cuprum, Ars. and Cup. sulph. My custom is to give a dose of Glonoine that is just short of causing physiological symptoms, morning and night, and other remedies as indicated.
 Diet is very important. Meat and eggs positively disagree with most patients; in fact, over eating of any kind of food. Cold baths and sea bathing should be prohibited in most cases. A winter sojourn in a warm climate, or in case patients cannot do this, in advanced cases they should be put to bed in a warm room during inclement weather in winter, especially during the high, cold winds toward spring in our long northern winters.
 For the severe rheumatic pains and muscular contractions that accompany this disease, persistent and long continued rubbing and massage with warm olive oil is helpful.
 Case, number 2, seemed as though she would never walk, but her husband was a man of energy and perseverance and after months of rubbing and oiling, was rewarded by seeing the contracted tendons give way and the legs straighten and become flexible.
 You will please bear in mind the title of this paper, “Some Personal Observations In the Treatment of Interstitial Nephritis.” I have not intended to go into an exhaustive study of the disease in question, but wish to emphasize the importance of as early diagnosis as possible, as a large percentage of the cases of cerebral haemorrhage is due to this disease on account of arterial tension. Just now arterial tension is beginning to engage the attention of the profession and some life insurance companies are demanding that their examiners provide themselves with the sphygmomanometer and measure the tension in every case applying for insurance.
 Again, let me reiterate, arterial tension suggests examination of second sound of heart, accentuation of which suggests examination of apex beat; found to left of nipple line suggests Glonoine. Tolerance of this should lead to accurate measurement of urine with repeated microscopic. Diagnosis established, Glonoine and Merc. dulcis seem to be the most reliable remedies.
Discussion 
 F. C. Askenstedt, M. D., Louisville, Ky.: The amount of albumin in the urine does not indicate the severity of the case. I know cases of terstitial nephritis at the point of death with only 6 per cent. (by bulk) of albumin in the urine, while I have seen others with the same amount and in apparent health. The quantity of albumin only indicates the amount of inflammation going on at the time, but does not show the amount of damage that has already been done to the kidneys. The paper we have just listened to is very good from a standpoint of diagnosis, but I do not approve of the continued use of nitro-glycerin in these chronic cases. The physiological action of nitro-glycerin is very brief, lasting but an hour or two, and as the patient rapidly develops a tolerance to the drug, it would be necessary to increase the dose at short intervals to continue the physiological effect. To administer such enormous doses as consistent treatment would require, can not be considered safe. Except in emergencies, I believe that our homoeopathic remedies will do all that we can hope for from any medicine. At present I have a case on hand which responded favorably to Merc. cor. for ten successive months. The patient had had a headache and some mental confusion before consulting me, but this passed away promptly, leaving him in apparent health as far as his subjective history goes. His pulse rate and quantity of urine have been normal, but a high systolic tension, varying from 165 to 200, is constantly present, his heart is hypertrophied, and his urine always contains some albumin (from 11/2 to 9 per cent. by bulk) and casts. A number of homoeopathic remedies have been given – singly, of course – and their effect estimated by the amount of albumin in the urine, practically his only symptom. After twenty months of treatment, it was found by computation that during the first ten months there was almost always a lessening of the percentage of albumin after the administration of Merc. cor. but this effect seemed to be lost after this time, for during the following ten months a slight increase of the albuminuria was noted under the Mercurius, even more so than under other drugs. Our remedies seem to stimulate the reactive forces to their uttermost, leading to a temporary improvement in the patient’s condition, but as the trend of the disease is inevitably progressive, no permanent improvement can be obtained. My experience with Merc. cor. also seems to teach that we have no specifics, since the remedy at one time useful becomes valueless at another.
 Of much importance in interstitial nephritis is a proper restriction of the diet. Unnecessary activity of an organ cannot but hinder its natural resistance to disease, and since a number of patients can easily maintain their standard weight on one-half of the amount of food they usually consume, the importance of a diet free from excess becomes obvious.
 Dr. Harper: Dr. Simonds will close the discussion.
 Dr. Simonds: I have not anything further to say, Mr. President. I simply give you what has done me good in regard to temporary agents.
 I think that too much emphasis cannot be laid on diet. Over-eating is fully as harmful as improper feeding. Of course, we know that in some cases meats must be prohibited entirely.
 I believe with the doctor that we can get no good from the physiological dose of Glonoine kept up a long time, but I could call up a great many cases that I have found in an unconscious condition that I have made a diagnosis upon the spot from the examination of the pulse and the condition of the heart, and a hypodermic of Glonoine has brought them out of that and given me a chance of doing something for them for years to come. Some of these patients have taken this remedy night and morning for a month at a time. Perhaps it might not be the right thing to do, but I believe that the tension is caused by poisoned blood. Of course, as I say, in many cases it is probably due to arterial tension caused by forcing the blood through the kidney which has become damaged, and the contraction in the substance of the kidney. 

Dr.Devendra Kumar MD(Homeo)
International Homeopathic Consultant at Ushahomeopathy
I am a Homeopathic Physician. I am practicing Homeopathy since 20 years. I treat all kinds of Chronic and Acute complaints with Homeopathic Medicines. Even Emergency conditions can be treated with Homeopathy if case is properly managed. know more about me and my research on my blog https://www.homeoresearch.com/about-me/
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