In extremely urgent cases of renal suppression the method of re lieving the renal congestion by cutting down upon the kidney and incising its capsule has been recommended and carried out. Decapsulation of the kidneys has certainly saved life in the acute nephritis of children. It is doubtful if the procedure of wet-cupping of the loins possesses any advantages over yenesection, and the washing of the blood is quite as effectually accomplished by the hypodermic injection of the saline as by direct transfusion. In less urgent cases dry-cupping over the kidneys may be resorted to, especially when there is much blood in the urine.
If the blood-pressure is high Nitroglycerin may be safely administered, and Oxygen is indicated when asphyxial symptoms are prominent.
On the disappearance of all urzemic symptoms the question of adminis tering diuretics will crop up when the secretion of urine is scanty and there is much anasarca remaining. As a rule it is safer practice to trust to saline purgation, but such mild hydragogue diuretics as Sweet Spirit of Nitre and the Citrate or Acetate of Potash may he tried. Digitalis in the later stage and Caffeine are valuable, hut should never be employed when the arterial tension is high. Stimulating diuretics like squill, broom and gin should be avoided, and cantharidin must never be used as a vesicant or counter-irritant.
The most formidable symptom is severe headache, which, however, is usually promptly relieved by a purgative, and when persistent small doses of Antipyrine or Sodium Salicylate may be given. Opium in every form is most undesirable. Obstinate vomiting is best relieved by small quantities of sour buttermilk, which neutralise the irritating action of the poison on the stomach; when of cerebral origin, its treatment must be on eliminatory lines.
The diet should be cautiously augmented, as the amount of blood and albumin in the urine gets less, the milk being supplemented by carbo hydrates in increasing amounts and vegetable soups, and at a later stage fish with egg yolk. Anaemia is always present at this stage, and the best
ferruginous preparation for routine use is the extemporised preparation of the Acetate of Iron prescribed as Basham's mixture containing to-15 mins. tincture of perchloride of iron with r dr. of liquor ammonix acetatis in water.
Should anasarca and albuminuria remain after the elapse of several weeks the treatment of the case and its complications becomes identical with that of chronic Bright's disease, but the routine use of the hot-air bath and saline purgatives Inay be safely continued daily for a period of two or three weeks as long as the patient's strength is maintained. At the end of this time the bath may be given every second or third day for three more weeks, the purgative being administered during the intervening days. A change to a warm equable climate is most desirable in cases which show a tendency to pass into the chronic form of the disease. For long after convalescence it is needless to say that the most scrupulous avoidance of chills and exposure of every kind is to be guarded against by warm clothing and by keeping indoors after sunset in all climates.
l'ar Nephritis, about the causation of which so much has been written lately, yields to the treatment suitable for a mild case of acute Bright's disease—rest in bed between blankets, a purely milk diet, mild saline purgation, a feeble diuretic like effervescing soda or potash water to flush the kidney, and according to some authorities the avoidance of salt. The researches of Keith and W. W. D. Thomson prove the great importance of functional tests for determining the extent of renal impairment in the non-resolving type of war nephritis, and these authorities testify to the value of alkalies in restoring the normal acid-base relationship when symptoms of acidosis supervene (sec page 19 and 20).