Acute nephritis presents a number of serious and often dangerous symptoms. Among these are severe general cedema, dropsical effusions into the serous sacs (as hydrothorax), uraemia (especially when beginning with cerebral manifes tations, as convulsions or coma), and, finally, inflammation of the internal organs, as pneumonitis, pleuritis, peri carditis, peritonitis, and meningitis. Recovery is quite common in cases of marked general dropsy in the absence of uraemia. Suppression of the urine, however, if it last more than twenty-four or forty-eight hours, is usually a fatal symptom. In those cases, also, in which the nephritis has a productive character, the prognosis is unfavorable, though life may, in some cases, be prolonged for several years.
Case of acute Bright's disease eliding fatally in seventeen days in a child, 3 months old, and not consequent upon a skin affection or scarlatina. T. B. Green ley (Amer. Pract. and News, June 15, '98).
Treatment. — The first object in the treatment is to relieve the congestion and inflammation, since the renal func tion is diminished by these conditions; by these means we restore the excretory function. It is, therefore, in order to restore the functional equilibrium by their antiphlogistic influence, that the single or combined use of diaphoretics and cathartics is employed, and not that the skin and bowels should be made to perform the work normally done by the kidneys.
Absolute rest in a warm bed and in a warm room is of primary importance, and, in order to promote a constant and free action of the sweat-glands, woolen underwear and blankets should be used. These measures are of importance both in mild and severe cases.
The diet should consist of bland liquid foods only, and the patient should be urged to drink freely of water (plain, distilled, or carbonated), lemonade, skimmed milk, or buttermilk, all of which are of especial value when hot. Thin meat-broths may be allowed later in the course of the disease, although a strict milk diet is preferable.
In rare cases in which there is severe pain, local blood-letting, by means of leeches or cupping over the loins, may be useful; these measures are seldom needed, however, and a more salutary effect may often be gained by hot fomen tations. Diminution of the oedema and the elimination of urea and other uri nary constituents retained in acute ne phritis are best attained by exciting a profuse perspiration. The congestion of the kidneys is also relieved by this vicarious action of the skin. The same
results may also be accomplished by means of the hot-air or hot-water bath and the hot wet pack; in most cases the last method proves effective. It is easily applied by wringing a blanket out of hot water, wrapping the patient in it, and surrounding him, first with a dry blanket and, finally, with a rubber cloth. According to the condition, the patient may remain in this improvised steam bath until free sweating has continued for an hour or more. Children suffering from scarlatinal nephritis may either be treated thus, or by immersion in hot water for twenty, thirty, or more min utes; the child is then wrapped in warm sheets or blankets, after lightly drying the skin, and warmly covered in bed. Hot air or vapor may also be generated beside the bed and introduced beneath the cradled bed-clothing by means of a tin funnel and pipe. The drinking of hot lemonade or soda-water, or of water containing spirit of Itlindererus, will stimulate the sweating. Should these measures fail, as in urmmia, perspiration may be started by an hypodermic injec tion of pilocarpine, to grain; it will then continue to pour out upon the application of heat. Serious conse quences sometimes attend the use of pilocarpine, and the heart and pulse must always be carefully watched. The sweating should be repeated as often as the patient's strength will permit, until the dropsy disappears.
The depression of the heart's action produced by pilocarpine is very similar to that caused by nicotine. The toxic effects of the drug are best overcome by atropine. Where toxic effects result from the administration of pilocarpine, the ordinary circulatory stimulants should also be resorted to. Probably the only cases in which pilocarpine could be used with safety are those in which there is simple hypertrophy of the heart, with a strong action. The contractive power of the heart is what should be depended upon as a guide. Its employment is cer tainly contra-indicated if there is any dullness over the lungs, or pneumonia, emphysema, pleurisy, coma, fatty de generation of the heart, or cardiac in sufficiency. To ascertain the condition of the cardiac muscle, auscultation with the binaural stethoscope is called for, and any impairment of the first sound of the heart should make one hesitate to use pilocarpine. C. J. Proben (Med. News, Aug. 1, '96).