NEP
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the calculate one; for the forrrler may, for a long time, affect a patient without any thing of a {lone being in the cafe ; and, on the contrary, a ftone may be long lodged in the kidneys, without its bringing on any fuch complaint as the nephritis. In the fimple nephritis there is always a fenfation of pain and heat about the loins, which is plainly perceived to lie deep within the flefli, but is never very acute. On the contrary, in the calculofe nephritis, the pain is violently (harp. In the fimple nephritis, the urine, after it has flood fome time, ihoots to the fides of the pot pellucid cryftals of a red ifh colour. But, in the calculofe, the heavy matter immediately precipi- tates itfelf to the bottom, and is fabulous and gritty; and the fimple nephritis is always greatly relieved by a gentle motion of the body, as walking, or the like ; whereas all motion of the body exafperates the calculofe nephritis. The nephritis is diftinguifhed alfo from the ifchiatic pains, Which fometimes run up to the fame parts, by its being evident- ly perceived to he deep within the flefli, whereas thofe pains affect the external mufeles ; yet there is fuch a connection and confeat of parts in thefe cafes, that not unfrequently the one is taken for the other.
Signs of it. Thefe are a pain in the region of the loins, which does not ufually affect both, but only, or, at leaft, principally, one fide, ufually the left. The pain is at firft. tenfive and dull, but afterwards becomes more acute ; in the beginning it is often attended with a chillnefs, and general trembling, which is fucceeded by a heat, and acrid gnawing, fcarce to be fupported ; and this is ufually attended with a want of appetite, and lofs of ftrength, and a continual, though not violent, thirft. 1 he fleep is unfound, and there ufually is ! either a dull pain in the head, or a vertiginous complaint, more or lefs violent ; and very frequently naufeas, and Teachings to vomit, attend the fits, or prognosticate the accefs of them. The pain never extends itfelf down the whole thigh, nor is that ever wholly numb'd, or rendered torpid by it; and the difor- der does not feem continual, but attacks the patient at differ- ent times, and thefe after confiderably long intervals, if he live regularly. The bowels are ufually coftive at the time of the fits, and there is a frequent want of making water, though ve- ry little is voided at a time, and that thin, when the pain is vi- olent; when it is more obtufe, the urine is commonly thick, and has, as it were, threads in it, of a fort of mucilaginous matter ; and to this it is to be added, that fometimes the fper- matic veflels which run to the teftes become hard and tumid. Men are more fubject to this difeafe than women, and of thofe, fuch principally as are plethoric ; and people in the middle and later periods of life, are, in general, more fubject to it than thofe who are younger. In general, young people are not fub- ject to this difeafe, unlefs it be from an hereditary difpofition, or fome very powerful, and violent, external caufes. Men are much oftener tormented with the nephritis than women, and none fo often fall into it as thofe who have omitted the ufu- al evacuations, and afterwards fall into violent exercifes ; and finally, people who have the gout and the fciatica, are ufually alfo nephritic.
Caufes of it. Thefe are principally the fupprefllon of natural
■ evacuations ; or the omiftion of habitual artificial ones ; the abufe of hot medicines of the diuretic kind, fuch as the oils of turpentine, and juniper, and the balfam of fulphur ; as alfo the over frequent ufe of venery, and the taking medicines to provoke to it; violent pailions, or great and fatiguing exer- cifes; external injuries by blows, falls, or the like; and the ufe of a too hot diet, and too much of ftrong liquors.
Prognojlics. The fimple nephritis may ufually be cured, if pro- perly treated, but the calculous one fcarce ever can ; and tho' all inflammations of the interna! parts are juftly accounted ve- ry dangerous, yet this is the leaft fo of all others, becaufe the urine continually palling through the part, ablterges and clean- fes it, and prevents corruption, or gatherings of matter. T'he greateft danger is in fuch as have a difpofition to generate cal- culous matter, and to hectics. In thefe cafes the difeafe is apt foon to change from its fimple nature.^
It is very rare that both kidneys are feized with this diftemper, but ufually the left alone fufters by it : the more inflamma- tory the ftate of the body is, the worfe it is with perfons af- flicted with this difeafe, and the more they are fubject to it : thus young people who have often a turgefcence of blood, ■ are more frequently fubject to this difeafe than old perfons, and are with more difficulty cured of it : and it is an obfervation as old as Hippocrates, that the coming on of haemorrhages from the internal hemorrhoids cures this difeafe.
Method of cure. In the time of the fit, the firft thing to be done is the opening the belly by a clyfter of the emollient kind, pre- pared of milk or broth. Simon Pauli exprefly directs, from repeated experience of its good effects, a decoction of the herb veronica, orfpeedwell, with fome oil, and a little fait. After this, powders of nitre, cinnabar, and tartarum vitriolatum, ftiould be taken every three hours ; and, towards the evening, there mould be mixed with one of thefe dofes, eight grains of diaphoretic antimony, and four of crab's e\ cs. Emulfions of the cold feeds in the cooling fimple waters, .are alfo of great ufe ; and to the common feeds ufed on this occafion, may be added thofe of poppies, and of carduus maris. In the mean time external applications may alfo be ufed with fome fuccefs ; 3
fuch as hags of chamomile, melilot, and fenugreek feed dry, and heated at the fire; as alfo the fpirits of ierpyllum, and the like, and the foap plaifter : to all thefe may be added the ufe of leeches, which are, indeed, a great relief in all the diflemperatures of the urinary parts ; and, finally, dur- ing the whole courfe of the cure, refrigerating and diluting liquors are to be drank in large quantities, as barley water, tea, and the like.
After the fit, the neceffary treatment to prevent a return, is to bleed regularly, fpring and autumn ; to take, at times, gentle purges of rhubarb, fena, and the like; to keep the hemorrhoidal difcharges in their proper ftate ; and the ha- bitual coftivenefs which ufually attends people in this dif- eafe is to be taken off" by a moift aud lubricating diet j and wine, and ftrong liquors, are to be avoided. Junkers Confp. Med. p, 216, feq.
NEPHROMETR.&, a name given by fome authors to the mufeles of the loins, called by the generality of medical au- thors pfote.
NEPHROTOMY, in furgery, the cutting into the kidneys, in cafe of the Hone being lodged there, and taking it out in the fame way as from the bladder.
This is an operation which has been very little practifed, and ufually fuppoled to be attended with very great danger : few authors who have treated of thefe difeafes have fo much as mentioned this operation, and the few that have named it, have generally condemned it. Sinibaldus fancying that it was an operation antiently practiled, ftrove very earneft- ly, indeed, to have it revived. He has called in the opi- nion of Hippocrates to fupport his account of its having been done with fafety, and advifes the furgeons to try their hand on brutes firft, and accuftom themfelves to the ope- ration, and then not to fear it in regard to men. It is certain that a ftone in the kidney is fo terrible a dif- eafe, that it is very much to be wiflied that fome fafe operation could be invented to cure it ; but it is unking too free with Hippocrates, to fay that he countenances or directs fuch an operation in general. His words feem to exprefs only the making an inciiion near the kidney ; but even if they are to be understood as directing the cutting into it, it is under fuch reftrictions, that opportunities will very feldom offer ; and, when they do, a common furgcon would not fcru- ple performing all that is directed, without either confulting Hippocrates, or trying his fkill upon brutes. Hippocrates on- ly advifes it in cafe of a fwelling and impofihumation, where there is matter formed, and the tumor manifefts itfelf upon the furface. In this cafe every furgeon would know it was his bufmefs to make an incifion. Phil. Tranf. N y 223. p. 434. Cafes requiring this are frequent, and that even without a ftone. An inflammation in a kidney degenerates into an abfeefs, and when matter is formed, the furgeon opens the tumor, and the matter is difcharged. Sometimes ftones bred in the kidneys caufe impofthumations ; the furgeon opens thefe, and the ftones are brought away together with the matter. Nay, nature herfelf has done the whole for fome people, and the ftones have made their way through the kidney, and through the integuments, &c.
Tulpius gives an account, from his own obfervation, of a man who had a ftone in his kidney, which, after many years, dif- charged itfelf through the loins, and occafioned a fiftula in the part, through which the urine was long voided, together with the matter. The attempts of many furgeons to heal this fiftu- la proved vain, and, at length, one fuccecding fo far as to flop up the mouth of the ulcer, the matter which ufed to he dis- charged from it was thrown into the abdomen, and the man died of a fever. Tulpius gives the death of this perfon as an ob- jection againft the operation of nephrotomy in general, as he fuppofes a fimilar fate might attend the wounds made in thefe parts by the furgcon.
From an impartial examination of the worksv of Hippocrates, it does not appear that the cutting for the ftone in the kidneys was regularly practifed in his time, nor, indeed, for many ages after ; for Celfus makes no mention of it, although he is very particular upon the operation of cutting for the ftone in the bladder. Galen is fo copious a writer, that he never miftes any thing practifed cither in his own time, or before it, in his accounts of difeafes, yet he mentions nothing of this ope- ration, though he Is very long upon the article of the difeafes of the kidneys. Cardan, indeed, mentions this operation as one of thofe of the am tents which were practifed in his time. His hafty reading the words of Hippocrates has led him into this error, and he lays the fault of its being now loft, in a treat meafure, on Galen's omitting to mention it. It is wrong to accufe Galen of this omiflion, fince neither Celfus, nor RufFus, who preceded him, nor Aretauus who was his cotemporary, nor, indeed, any of the Greek or Latin phyficians, have named it, though they, as well as the moderns,, mention occafionally an abfeefs in the kidneys, and the manner cf curing it. The Arabians, indeed, mention the operation as practifed and countenanced by fome perfons before their time ; but they aJI join in condemning it as a bold and hazardous operation, from which very little good is to be expected, and which fets the life of the patient in the moft imminent danger. Avifenna fpeaks of it as the act of a madman, and, it feems, that it was
fometimes
