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this certainly does dilate the superficial vessels, and the general arterial tension must necessarily fall.
Static electricity in the treatment of Bright's disease, according to Professor Nuswanger's report, are phenomenal. The manner in which the nervous system influences the secretion of the various organs by causing them to respond to the vibration caused by electric currents is quite plausible. I shall, therefore, quote in part what Nuswanger says in the chapter devoted to the treatment of chronic Bright's disease. Nephritis is a disease of central nervous impairment. The path by which impressions are conveyed to the kidney are the splanchnics and the spinal cord, and whenever this nervous tract is impaired the kidney function is affected.
The other remedies indicated in the treatment of this disease are those that will hasten the oxidation of waste products.
The result of decapsulation of the kidney is a complete failure, and has no place in the successful treatment of the disease.
Static electricity is the logical remedy, because the evolution of oxygen always accompanying this modality not only hastens the elimination of waste matter, but gives a better tone by its vibratory action to the nerve centers affected. Static electricity is a powerful equalizer of the nervous forces, as is evidenced by its influence on the temperature, respiration and pulse. It will temporarily reduce a high temperature, or it will elevate a low or subnormal temperature. It will reduce a high pulse or raise a low pulse.
You can also see the good effects of static electricity in the increased elimination of waste products, such as urea, CO2, sweat, etc.
Take a patient suffering from poor circulation, having
cold feet and hands. Include him in the static circuit, and a little while his feet and hands are warm and he is perspiring. What does it?
Simply the equalization of the nervous forces.
Every day brings evidence that convinces the author more firmly than ever that nephritis is a disease of central nervous impairment.
The natural paths along which impressions are conveyed to the kidney are the splanchnics and the spinal cord, and whenever this nervous tract is impaired the function of the kidney is correspondingly affected.
Bernard has produced albumin in the urine by irritating a certain portion of the fourth ventricle.
The author was forced to the conclusion of the nervous origin of this disease by the character of the person affected.
We rarely find a hard-working man of the laboring class having this trouble, but it is people who use their brains, those who have mental worry. Doctors, lawyers and preachers-in other words, it is the people who press the button that rings up the great sympathetic until the battery which moves it is exhausted.
Grief alone has been known to produce Bright's dis-. ease. How could grief produce the disease if it were not through central nervous channels?
So it is through the nervous system that the wonderful effects are obtained by electricity.
From the very beginning our patient begins to improve. There is increased elimination of urea, albumin, disappears and the oxidation is complete. The microscopical examinations fail in a short time to show casts of any kind. in the urine.
The treatment advised by Dr. Nuswanger, in most cases is the negative head breeze for fifteen minutes, fol
lowed by positive insulation for the same time. The Morton wave current to the spine is alternately substituted for the head breeze.
DISCUSSION ON DR. HANIE'S PAPER.
Dr. F. W. McRae, of Atlanta: The essayist made a statement to which I shall have to take exception, and that was, there is absolutely no value in the surgical treatment of Bright's disease. I know four men whose lives have been saved by the surgical treatment of this disease. Three of the operations were done by Dr. Edebohls, of New York. I did one myself. I had occasion to follow up the cases. One of them was a medical student, who first matriculated in the university. A diagnosis of nephritis was made and confirmed. He was kept under observation during the entire session, and at the close of the session he was advised to go home, but he chose to go to Dr. Edebohls, who decapsulated both kidneys and kept him under observation for a considerable time. He was a third-year medical student. He came to the Atlanta College of Physicians and Surgeons the following year, and put himself immediately under my observation. I had the history of the case from Dr. Edebohls. The patient himself was intelligent, and 1 watched the case during the entire session. Every three or four weeks I examined the urine. He went through and graduated with distinction, and has remained well ever since.
Dr. Nicolson knows of one case that is practically cured, although the man still has a little albumin is his urine.
One of my own cases, a man, sixty-four years of age, who was practically moribund, had been treated by all the different methods that are employed, and since I gave up general practice I was called in consultation and found
him practically comatose. He used liniments and various remedies, and gradually grew worse, until he was in a dying condition. I suggested operation to his wife, and she consented, and almost without knowing he was being taken to the operating table we operated on him, and not only decapsulated but opened the kidneys. It has been four years since the operation was done, and he is now enjoying good health and apparently has been cured.
I have operated on one young lady within the last few months in whom I did double decapsulation, and I would like to have Dr. Block say a word or two with reference to that case, as I do not know what has been the result. Clinically, she improved after the double decapsulation, and three or four weeks later I removed the appendix, did some abdominal work, and she went through that without any trouble. I have seen all signs clear up repeatedly in these cases where one kidney was enlarged and where there were albumin and casts in a case of movable kidney from decapsulation and nephropexy.
Dr. E. B. Block, of Atlanta: I will say that the patient upon whom Dr. McRae operated had edema of the feet before the operation, which subsided under rest and diet before the operation, and that the operation did not cause any appreciable diminution in the quantity of urine which she had been passing, and that the albumin slightly increased immediately following the operation, but subsequently sank lower than it had been before the operation. While it is a mooted point as to how much importance we should attach to the quantity of albumin found in the urine, still I would rather see a decrease in the quantity of albumin in the urine of my patients than a large quantity, but whether it has any significance I am unable to
In regard to some of the remarks made by the essayist,
I will say that in the toxic states of Bright's disease, where there is a profound toxic condition, a stuporous condition, coated tongue and fetid breath, very copious draughts of hot water, given every hour or so, are unquestionably valuable when combined with diaphoretics and pilocarpine injections, and I think we will find that hot water does far more in these cases than any drugs we know of. In the juicy cases of Bright's disease, where there is a great pouring out of fluid, dry diet is of value, in that it helps to reduce the extreme edema where there is a pouring out into the bronchial tubes and effusions into the chest.
Dr. J. W. Duncan, of Atlanta: I am glad that Dr. Block mentioned the use of hot water, as I believe the essayist did not suggest that any fluids be given to a patient with Bright's disease. That is a strange thing for this Association to sanction, namely, to give a patient no fluids whatever in this disease, when we know that the human body is largely water, and I am glad Dr. Block mentioned giving hot water. Above all things, I think a patient ought to have some fluid in this disease.
Dr. J. W. Daniel, of Savannah: I think Dr. McRae misunderstood the situation. The essayist, in reading his paper, made a general classification when he spoke of Bright's disease, and he did not say what form of kidney lesion he has special reference to.
Dr. McRae stated that his operation was successful in large congestive kidney. In the kidney probably that the doctor was referring to he had reference to small granular kidney, in which we get an arterio-sclerotic condition. In these conditions decapsulation is of no value, because there is no tension on the capsule, for which Dr. Edebohls advocates his operation.
Dr. Block said that hot water and diaphoretics are of