Course and Prognosis.—In slight cases without severe hydrops or urtemic symptonis, a cure is usually effected in the course of three weeks. In serious cases, in spite of high grade oedema and urtemic intoxication, it is still possible to obtain recovery in the course of weeks or months. The marantic condition which develops in connection with a nephritis as a result of heart insufficiency, often becomes a special danger. On the whole, it may be said that the more serious the asso ciated general conditions, the more dangerous is the nephritis. Per sistent high or remittent fever, tachycardia and brachycardia, lack of appetite and serious intestinal disturbances, aggravate the prognosis. The same may be said of anuria, which almost always terminates fatally if it persists for several clays. Family tendencies and the vicar ious power of the skin must be considered in establishing the prognosis. In spite of the dangers involved in these statements, the prognosis of scar latinal nephritis is relatively favorable. According to Iieubner six-sevenths of the cases are cured. Whether scarlatinal nephritis often becomes chronic or not, has not yet been unequivocally answered. Unfortunately, there is not yet at our disposal a sufficient number of lengthy obser vations to determine this question; a factor which is of particular importance in judging of the nephritis of babies. IIeubner believes that chronic nephritis is not so rare as a sequel of the acute form, but that the latter will seldom be diagnosed, because the objective disturb ances are, as a rule, not sufficient to induce us to examine the urine. The pallor of the child is the only conspicuous symptom; sometimes they complain of headache. The uranalysis in the chronic stage shows a greater or lesser percentage of albumin, and casts in greater quantity, but this is only true during aeute exacerbation, which may present the appearance of the original acute inflammation, with all its complications. As long as red blood corpuscles continue to be present in the urine, the chances of an ultimate cure are always greater than when they are completely absent, and when the albumin coagulated by boiling shows a pure white tint. Heubner and Dixon Mann have described a con tracting kidney secondary to scarlatina] nephritis, which is incompatible with long life.
To the process of recovery from acute nephritis, the night 'trine first becomes free front albumin, while the urine passed (luring the day still contains it. It is advisable to differentiate this form of orthotie albuminuria from the so-called essential one. In this form a thorough examination will almost always reveal the presence of casts.
Treatment.—Thc question as to whether there is an effective dietetic prophylactic treatment for nephritis, may be answered in the negative in the very beginning. Even though there be no reason to desist from a milk diet during the first weeks of scarlet fever, if the children take this food willingly, it is wrong to force its use if they rebel against it. Cereal pawls and a vegetable diet do quite as well, and are not more prone to be followed by nephritis. Widowitz asserted that by giving urotropin during the first days of scarlet fever, antl at the beginning of the third week the development of scarlatinal ne phritis might be prevented, but his assertion has been refuted, not only by Garlipp, but by numerous cases in Heubner's Clinic. Weigert be
lieves that since urotropin is harmless, its application may be recom mended until further experience in every case of scarlet fever.
Heubner recommends while the renal disease is active, a plentiful supply of milk, which is of value as a mild diuretic. Vegetable diet and cereal gruels may be given without hesitation (von Noorden). The time is past when it was considered a serious fault to replace milk by any other kind of diet. A meat diet is to be avoided, because Weigert demonstrated by examination of the metabolism that it has a most unfavorable influence upon the excretion of albumin. It will be advis able to encourage diuresis by a liberal supply of some mineral water (Wildunger, Biliner).
Special therapeutic measures must be taken to meet a marked decrease in the amount of urine, the beginning of urfemia, and the appearance of high-grade (edema. If the amount of urine falls below 500 c.c., we must resort to hot baths, 35°C. (95° F.), gradually increased to 38° C. (100° F.), in which the child is kept for from 10 to 15 minutes, after which it is wrapped in dry or wet cloths. A liberal supply of tea, as well as the previous internal use of pilocarpine (see the treat ment of infantile nephritis), furthers sweating. Hot poultices over the region of the kidney (three times a day for two hours), are fre quently of equal value to produce diuresis. Should the quantity. of urine sink still lower or serious symptoms of unenda appear, there should be no hesitation in performing veneseetion. About one-tenth part of the blood should be removed (the total quantity of the blood is about one-thirteenth of the body weight), either by veneseetion or by the application of leeches in the region of the kidney (an active leech removes about 10 Grn. (2?,. dr.) of blood; as much as will leave the body. in bleeding afterwards). The withdrawal of blood may be followed by an infusion of common salt. A convulsion may be effectively com bated by a large dose of chloral hy-drate, 1 to 2 Gm. f15-30 grains), intro duced by enema.
Heubner warns us of the possibility that effective diuretic medi cine may increase the hyper(emia. In case eardiae weakness develops, we use first of all injections of eamphor, 0.05-0.1 Gm. grains) two or three times in an hour). Heubner recommends digitalis only in eases of desperate heart weakness. According to Steffen the secale cornutum textr. fl. secal. cornuti 3-4 Gm. (45-60 grains), aqua 100 c.c. (3.1 oz.), 10 e.c. (21, dr.) 3 to 4 times daily), is of value in the weakness resulting from cardiac dilatation.
If there is marked (edema, a diet containing very little common salt is of the greatest importanee (Strauss). Weigert in common with other writers has shown that a salt free diet without. any other medi cine, may cause the complete disappearance of (edema. If the accum ulation of water depends not so much upon the insufficiency of the kidney as upon that of the heart, we need not refrain from the use of stronger diuretics (caffeine, diuretin).