The differential diagnosis from cystitis may be difficult because this condition is often a complication of the gastro-intestinal diseases of infancy (see chapter on eystitis).
Among the clinical symptoms is to be mentioned ceclema, which is a valuable diagnostic sign, even though it does not absolutely prove the existenee of nephritis. Convulsions, debility, low spirits, vomit ing are all too ambiguous to warrant their acceptance pathognomonic of a urtemin intoxication. But Politzer considers that elevation of the fontanelle, with marked resistence and incompressibility, a valuable sign of nephritis, and mentions also convulsions, sighing and vomit ing. With reference to the funclus of the eye the literature is not exten sive enough to enable us to draw any definite conclusions.
Course and renal symptoms may disappear along with the intestinal disturbance, or they may persist for a little longer. The cases in which the improvement in renal and intestinal symptoms is simultaneous seem to be those which result from toxins. The eases which persist after the intestines are well appear to be clue to infection, but this is not true of every ease.
Chronic, nephritis may clevelop in any case, but conspicuous symp toms may not be present, and frequently the only diagnostic sign will be found in the examination of the urine. According to Heubner exten sive hydrops is especially rare in the chronic cases.
In one of my own cases of nephritis due to enteritis, hydrops per sisted for over a. year in varying degree, until finally a cure was effected.
It has been definitely proven that in the acute stage, death may occur from unernia, but owing to the meagre number of clinical and histological reports we cannot determine whether this is very frequent or not. The purely elinical answer to this question is diffieult because the very symptoms, which are considered to be urmmic, often admit of another explanation. As has already been stated, the prognosis in the aente cases is not unfavorable, and even in the ehronie form recovery may take. place even after several years. The prognosis is influenced not only by the severity of the symptoms, but also by the condition of the child's nutrition. The judgment of the child's prospects is decidedly influ enced by the proper or improper character of the previous nutriment.
A serious complication, and one whieh endangers life, is the occur rence of thrombosis of the veins. In some eases this accident is manifested
by the sudden appearance of bloocl in the urine, but in other cases it may be followed by complete suppression of the urine. Palpation gen erally shows marked enlargement of the kidneys. Frfihwahl has de scribed thrombosis of both renrd veins, without previous renal disease, and consecutive infarction of both kidneys, as a complication of cholera infautum. The ease was one of typical enteric catarrh, in which a dis charge of almost pure blood suddenly appeared. The autopsy showed a marantic thrombosis of both renal veins, with consecutive infarction of the renal tissue. The kidneys were enlarged, to four or five times the normal size.
Therapeutics.—Proper feeding is of thc utinost importance. Good breast-milk stands at the head of the list, and if this cannot be obtained pure row's milk should be given. Where there is repugnance to the milk, it is sometimes more willingly taken raw. Artificial food prepara tions rich in salt (as Liebig's beef, Kufeke, Theinhardt) should be avoided in order to prevent the tendency to (edema, or to assist in its removal if it is already present. The use of hot packs is to be recommended. The child is put into a bath at 39-16° ('. (102.2°-104° F.), remains there for about ten minutes, and is then wrapped in a wet sheet and a woolen blanket in such a manner that the head alone remains free. If there is great weakness a dry linen or woolen covering is used instead of the moist paek. The child remains in the pack for 20 to 30 minutes after the skin begins to act, and perspiration is favored by the free admin istration of hot teas. The child must be watched very carefully during the process, and any tendency to collapse is met by the administration of camphor subcutaneously. The hot pack should not be used oftener than once a clay, because it is not without decided depressing effects. lf the pack does not produee sweating, piloearpine should be given internally (pilocarpine 0.02 Gm. (-1 gr.) aqua 50 e.e. (II oz.). Give 10 c.c. dr.) at the beginning of the pack. In case there is great decrease in the quantity of mine, or if urternie symptoms evidence themselves, hot poultices should be applied over the region of the kidneys. The sovereign remedy for urtemia is blood letting (see thera peutics of scarlatina] nephritis).