Symptoms. — In  the  chronic  forms  of  kidney  disease  a
disturbance  of  digestion  is  often  the  sole  subject  of  complaint,
and  in  the  absence  of  a  careful  examination  of  the  urine  the
gastroenteritis  is  apt  to  be  erroneously  regarded  as  the  primary
disorder.  The  symptoms  vary  at  first  according  to  the  na-
ture of  the  secondary  gastritis.  Thus  in  parenchymatous  neph-
ritis the  inflammation  of  the  tubular  glands  of  the  stomach  is
accompanied  by  vomiting,  constipation,  and  pain  after  food,
while  the  interstitial  gastritis  that  accompanies  the  granular
contracted  kidney  gives  rise  to  loss  of  appetite,  nausea,
flatulence,  emaciation,  and  an  irregular  action  of  the  bowels.
Vomiting  in  kidney  disease,  like  that  which  results  from  other
toxaemias,  occurs  both  in  the  early  morning  and  after  meals.
In  the  former  case  nausea  is  experienced  as  soon  as  the
patient  rises  from  bed,  and  after  much  retching  a  little
alkaline  mucus  tinged  with  yellow  bile  and  mixed  with  saliva
is  rejected.  Emesis  after  meals  may  either  occur  at  once  or
be  postponed  for  an  hour  or  two,  and  the  ejecta  then  consist
of  undigested  food,  mixed  with  an  excess  of  mucus,  and  almost
devoid  of  hydrochloric  acid.  Sooner  or  later  the  stools  become
frequent  and  loose  in  character,  and  progressive  loss  of  flesh
occurs.  If  the  kidney  trouble  shows  signs  of  amelioration  the
symptoms  of  dyspepsia  also  improve  for  a  time.
The  onset  of  acute  uraemia  is  almost  invariably  marked

by  an   access   of   vomiting  and  pain  in  the  head.     Emesis

occurs  at  frequent  intervals,  is  excited  by  every  attempt  to

swallow  food,  and  in  many  cases  an  extreme  degree  of  gastric

25


386    DISEASES    OF    THE    KIDNEYS  AND    URINARY    ORGANS.
