III some eases, after the intestinal symptoms have subsidtsl, the only indication that points to nephritis is that the ehild does not rally, but gives the impression of being still seriously ill, and this is only explained when the urine is examined. In other 0:16('S the appearance of mdema points to the kidneys as the seat of trouble. The face becomes gradually pale, waxen and bloated, the indenta spreads to the extremi ties, and may develop into a general anasarea. The urinary excretion beeomes scanty, 01' there may be complete :nutria, and if the Urine is passad upon the diaper this may look as if it had been soaked with a blood-stained fluid. Rapid pulse, higher temperature, and slight dysp meet may complete the picture. Vomiting, convulsions, and somnolence indieate the onset of urtemic intoxication. On palpation, the kidneys often seem to be enlarged and tender to pressure.
The nylona of infancy requires a short discussion. At this age it does not always indicate an anatomical renal disease. tithough this is sometimes true of adults, it is deserving of etnphasis that in babies the idiopathic cedenta without the appearance of pathogenic elements in the urine, contrary to the tendency of later life, is relatively a common condition. Wagner drew attention to this fact in IstiiT, and it has since then been confirmed by the farther observations of llutinel, (tassel, and Stilltznett. This disturbance has been attributed to diseases of the heart, of the vessels, to caehexia, and to toxins. In a case which came to autopsy, Ludwig F. Aleyer was able to exelude any anatomical dis ease of the kidneys by a thorough histological examination. Itutinel has insisted upon the groat importance of the ordinary sodium chloride of the food in connection with the appearance of the idiopathic (edema.
The increase in the cedema when the amount of salt is increased corre sponds with the decrease which follows the reduction in the chloride. The phosphates and the other nutritive salts have the same influence (Ludwig F. Meyer). We are obligecl to admit without reserve the cor rectness of the theory established by Bartels ancl others that the appear ance and increase of ceclerna is in proportion to the diminution in the quantity of t.he urine. This decrease may be either the cause or the consequence of the oidema. Both possibilities must be admitted (F. Muller). According to Stfiltzner it is impossible to escape the supposi tion of a lesion of the capillary walls to explain the cedema. This opinion is strengthened by the beautiful experiments of Ileinecke who produced (-edema in animals 1)2,, injecting small quantities of blood serum taken from animals suffering with oedema due to the action of metallic poisons.
It is also possible that the cuderna may be the result of functional dis turbance of the organs which ordinarily take care of the elimination of the salts. This is the function of the epithelium of the urinary tracts. If these epithelial cells are so damaged by a certain percentage of salt in the blood, that they beeome unfit for their duty, the result i,s an over charge of the blood with salt, which will be discharged into the tissues and produee an (edema by earrying the water with it (L. F. Meyer).
Pathological Anatomy and and Hirsch sprung deseribe the pathological changes in the nephritis of gastro intestinal diseases as follows:—Alterations in the renal parenchyma, high-grade fatty degeneration of the epithelium of the convoluted tubules, turbid swelling of the epithelium of the tubuli recti. Epstein, Czeruy- and Moser also found alterations in the convoluted tubules:— "the epithelial cells of the tubuli contorti are greatly enlarged, the protoplasm is granular, the nuclei are susceptible of being slightly stained, the Malpighian corpuscles and the tubuli recti are sharply dis tinguished from the diseased tubuli contorti by an intensive eolor." III some cases Czerny and Moser found areas of infiltration in the renal cortex, consisting of round cells or of red blood corpuscles, but they never found any diffuse infiltration. Microorganisms were found in the exudate and many of the blood vessels were completely filled with them. In CaSCS complicated by venous thrombosis the relation of this complication to bacterial emboli was established by Czerny and Moser.
The results of the examinations of Czerny and Moser permit us to clivide the haqncitogenous nephritis due to gastro-intestinal diseases into two forms: one dependent upon bacterial embolism, the other the result of toxins. A bacteriological examination of the blood will be of service in enabling us to make the differential diagnosis between the two.
diagnosis can be established only by examina tion of the urine. If we wish to avoid the use of the catheter in children, we may make use of the cone devised by Erlenmeyer, fastened in place by means of adhesive plaster. Catheterization is a method easily practiced, and provided proper asepsis is observed it is free from any danger (Hirschsprung). Englisch has devised a catheter for use in in fants with shorter tip and slighter eurve.