388 DISEASES OF UNCERTAIN .ETIOLOGY 



The urine is dark brown, acid, separates on standing into two 

 layers, the upper clear or port-wine colour, the lower brownish grey 

 with hyaline, and hb. tube casts and debris. Red cells are few or 

 absent. 



Epithelial cells may be seen. 



TREATMENT. 



Rest in bed is absolutely necessary with the best nursing available. 



The patient must not move if the attack is severe. 



All kinds and plenty of bland fluids as the stomach will retain them. 



Calomel followed by mag. sulph. can be given with care. 



Hot, moist applications over the stomach and loins and hot-air 

 baths are always good. 



If parasites are present cjuinine is indicated, but the results must 

 be watched. If the condition is aggravated withdraw it for a few days, 

 and then repeat it. 



The chief essential indications are : — 



(i) To flush the kidneys. 



(2) To raise the blood-pressure. 



(3) To strengthen the heart. 



Give digitalin, ergotin and morphia for the vomiting when present. 



Normal salines, and plenty oj them, must be given one way or other. 



These can be given per rectum with a rubber catheter well inserted ; 



Or, and also subcutaneously, 8 to 16 ounces every three hours; 



Or, and also intravenously (Rogers), four pints at a time. 



Some claim good results from salvarsan given in two pints of 

 saline (Burkitt). 



Burkitt and MacGilchrist agree that the cause may be due to 

 increased alkalinity of the blood, in consequence of which the former 

 administered potassium and sodium bicarbonates with success, giving 

 them in i drachm doses hourly in plenty of water. 



When the danger is past give some mild ferruginous preparation, 

 followed by Fowler's solution. 



Syphilis when present must be treated as soon as possible. 



The patient should leave the district early and advised not to return. 



The saline treatment is all-important. Fluid must be passed into 

 the circulation. It is useless to give pilocarpine when the blood has 

 little fluid to give up and the kidneys already exhausted by the lack 

 of it. 



All urine must be carefully measured and the time noted when 

 passed. 



If the amount is decreasing put in more fluid by mouth, rectum, 

 subcutaneouslv or intravenouslv, until the amount increases to the 



