:Morphine hypodermically employed is of conspicuous benefit in the shortness of breath of ummia. timeline asthma yields promptly to hypodermic injections of morphine. On the other hand, persistent distress of breathing may be due to dropsy, and such a condition is not im proved by the use of morphine. The headache and sleeplessness occurring in urcemic patients can generally be re moved by the hypodermic injection of morphine. Sydney Ringer (Jour. of Amer. Med. Assoc., Oct. S, 'OS).
Low tension, with scanty albuminous urine, oedema, and signs of dilatation, requires heart-tonics and stimulants, in conjunction with purgatives. Digitalis is effective, and especially in combined with strychnine nitrate or with caffeine citrate. The dropsy calls for calomel and the salines.
ITrlemic symptoms are to be managed. as in acute Bright's disease, by means of free catharsis and profuse sweating, and occasionally by phlebotomy. In convul sions, severe headache, or dyspncea, in halations of amyl-nitrite or chloroform. or the hypodermic injection of morphine, V, grain, may be tried. When there is a probable malarial or syphilitic origin. contracted kidney may be benefited by the use of arsenic and the iodides, re spectively. No medicaments. however, can ever transform the connective-tissue cells into secreting kidney-cells or re store the destroyed renal parenchyma.
To analyze thoroughly the results of treatment in Bright's disease one must have a clear conception of the histology and physiological functions of the kid ney. Its complex pathology must be clearly understood. All the etiological factors must be given full consideration. The etiological factors are numerous and very complicating in their action. Only one, it any, of these can be reached by surgical intervention. Most of the etiological factors can be modified or removed by well-directed dietetics and therapeutics. Histologically speaking, Bright's disease can be cured. Phys iologically speaking, the etiological fac tors can be modified, and often removed, the symptoms held in abeyance, while the renal glands perform their functions normally. Bright's disease is by nature an oscillatory malady, accompanied with frequent remissions and exacerba tions. Remissions must not be mistaken for cures. Rational dietetics and thera peutics offer the largest possibility for a complete physiological care. A well regulated mixed diet, especially if com posed largely of the animal class, when it can be tolerated, yields the best re sults. All therapeutics to be rational must be directed, not at the pathological lesion per sc, but toward establishing a more perfect digestion and metabolism and a decrease in the work imposed upon the renal glands. W. H. Porter
(Medical Record, Sept. 27, 1902).
The surgical treatment of Bright's dis ease seems to afford considerable hope as a source of relief and, in some cases, of cure. "During the past year," says an editorial writer in the Journal of the American Medical Association, Nov. 15, 1902, "there has been a great deal of in terest in this subject, particularly since the appearance of Edebohls's paper (Med. Record. Dec. 2.1, 1901), in which he claimed eight complete recoveries from various forms of chronic Bright's disease at least one year after decortiea tion of the kidney. After report of such brilliant results several operators took the procedure, but with less satis factory results than Edebohls reported. It seems certain, however, that operative measures relieve or cure certain cases of nephritis, and it is a highly-important question to determine just what classes of cases are suited for intervention.
"From a careful study of a series of 17 cases which he has operated on for vari ous forms of chronic nephritis, Rovsing, Professor of Surgery in the University of Copenhagen, attempts to formulate sonic rules as to the proper treatment in such cases. He divides the cases into aseptic and infectious nephritis. In the aseptic cases he found that diffuse parenchy matous nephritis was not influenced by operation. A case which he classed as chronic glomerulonephritis recovered af ter operation, he believes, more from rest in bed than from any favorable re sult from the operation. In diffuse limn orrhag,ic nephritis there is much danger in operating and the results are not sat isfactory. In four cases of interstitial nephritis and perinephritis fibrosa oc curring with uric-acid and oxalic-acid diatheses his results were satisfactory. Operation is frequently undertaken with a diagnosis of stone in the kidney in such cases and gives relief without any stone being found. The severe pains which are present in these conditions lie be lieves indicate operation. Pain always indicates tension within the kidney cap sule, it does not matter what form of nephritis exists. But the most impor tant group of cases is that caused by some form of infection. Eight of his cases were of this character and the con dition was only discovered after most painstaking examination. Yrine ob tained under aseptic precautions should be accurately examined chemically, mi croscopically, and bacteriologically, in every case, whether we suspect that we have to deal with an infection or not.