TREATMENT - CHRONIC PRODUCTIVE NEPHRITIS WITHOUT The progress of the nephritis can be favorably affected by atten tion to the diet and mode of life, and to climate. As regards the diet, the quantity of sugars and starches taken should be restricted, and the ingestion of fats encouraged. The use of wine, spirits, and tobacco should be discontinued. Exercise in the open air is to be advised as long as the strength permits of it. As regards climate, we must consult the idiosyncrasy of the patient; it should be a climate where he eats well, sleeps well, and feels well. There is a decided advantage in not remaining in the same place throughout the year.
In the patients belonging to group one, with urine of low specific gravity and hypertrophy of the left ventricle, it will be found that whenever the tension of the pulse is increased the patients do not feel quite so well. When this is the case potassium iodide will often soften the pulse and remove the discomforts. These patients can also be much improved by regulated exercise in the open air.
In the patients belonging to group two the treatment is directed to the digestive disturbances and the nutrition. The regulation•of the diet and the mode of life, lavage of the stomach, relieving constipa tion, and increasing the production of bile are all of importance. When the production of urine is largely in excess of the normal, com binations of nux vomipa and sodium bromide will sometimes act as a specific in reducing this undue quantity.
In the patients with attacks of spasmodic dyspncea much can be done with the drugs which dilate the arteries and stimulate the heart. According to the tension of the pulse and the strength of the heart's action, we use these drugs separately or together. Chloral hydrate, nitroglycerin, and potassium iodide are the most reliable of the arterial dilators; digitalis, strophanthus, and caffeine are the best cardiac stimulants for this purpose.
The treatment of the attacks of headache, convulsions, coma, hemiplegia, and vomiting is a matter of importance. The only work ing theory that one can go on is to believe that at the time of these attacks there is an irritant poison in the blood which causes con traction of the arteries, and that the cerebral symptoms are due partly to the contraction of the arteries and partly to the poison it self. What the poison is or whether it is in all cases the same poi son we do not know.
Evidently the indications for treatment given by this theory are, first, to remove the poison from the blood and, second, to dilate the contracted arteries.
The plans which are ordinarily used to remove the poison from the blood are : general blood-letting, purging, sweating, and diuresis. These measures unquestionably can do much good. Whether they do so because they remove poison from the blood, or because they relieve the arterial tension, is a matter open for discussion.
Dilatation of the arteries can be effected by hypodermic injections • of morphine; by nitroglycerin, chloral hydrate, and potassium iodide; and by sweating. Very often with these remedies the pulse will become soft and the cerebral symptoms will disappear. But after the nephritis has advanced beyond a certain point it is found that all these remedies are inert; the tension of the pulse and the cere bral symptoms continue. Or, instead of this, the pulse loses its ten sion, becomes rapid and feeble, the cerebral symptoms continue, and the patients die.