The prognosis, therefore, is not favorable, although there is no reason to abandon all hope of recovery in every case. This is shown by the observation of some cases in whom a cure was effected about the age of puberty; but the individuals who recover during this period are often left with a lowered resistance which predisposes them to relapse.
Treatment. it is a melancholy confession to niake that the treatment of the above-mentioned forms of chronic nephritis is almost useless. Only in the hieniorrliagic types is Heubncr inclined to aseribe any curative value to long-continued rest in bed, absolute milk diet, and diaphoretic treatment. This is not true of the other forms, on the contrary it would be a mistake to keep patients with contracted kid neys or doubtful nephritis in bed for a long time. They simply lose their appetite and the subjective symptoms increase. These children should go tranquilly to sehool, and they should not be prohibited from play, work and bodily exercise; they should only be guarded against cold and overexertion. During the summer vacation a temperate mountainous region is to be preferred to a sojourn at the sea-shore. The diet should be varied, only an excessive meat (Het being avoided (Weigert). Alcohol should not be given. The Carlsbad cure is worth trying, and in the case of patients who are inclined to ceclema, in con sequence of the large white kidney, a diet free from salt is to be recom mended. In regard to the organic therapeutics recommended by the French and the Italians, we, in Germany, have little experience.
(e) Amyloid Degeneration of the Kidney According to Wagner's statistics, four and one half per cent. of cases of amyloid degeneration oceur in ehildren under ten years of age.
The etiology and pathological anatomy are the same as in adults, the causes being protracted suppuration in the bones, glandular tubercu losis, malaria and syphilis. Amylaid degeneration has also been ob served after a relatively short time (thirty days) in the diphtheritic kidney. The urine is light in color and its quantity is increased. The
greater portion of the albumin, which is formed in abundance may con sist in the albumin body precipitated by avetic acid (Senator, Joachim).
The clinical progress depends on the original disease. Gastro intestinal symptoms, especially cliarrInva, are frequently present.
The prognosis is unfavorable, death occurring after a few months frcin marasmus or uriemia. Improvement is only possible if the orig nal disease (syphilis, suppurations) is healed.
Diagnosis is based upon the presence of the etiological factors, together with the swelling of the liver and spleen which is usually found at the same time.
3. Suppurative Nephritis This affection may originate from emboli (heematogenous) car ried in the blood stream, from inflammatory diseases of the urinary discharging tracts (as.cending), or from suppurative processes in the neighborhood of the kidneys. The hwmatogenous form is character ized by symptoms of a general pylemia.
The diagnosis is suggested by the presence in the urine of casts, and masses of pus which represent a serious sepsis. If the kidneys are painful and can be palpated, the diagnosis will be easier.
The prognosis depends upon the nature of the original discase, and treatment must Ile directed to the latter. A termination in con tracted kidney is possible. Renal suppuration resulting from ascending inflammation is not easily recognized because the symptoms of the in flammation of the urinary tracts (cystitis, pyelitis) dominate the pic ture. But the participation of the kidneys may be suspected if there appear severe toxic and septic symptoms, marked general disturbance, complete loss of appetite, vomiting, profuse diarrlicea, high remittent or intermittent fever, and if palpation shows the kidneys to be enlarges' and tender. The condition of the urine hardly differs from that seen in cys topyelitis (see special article). The participation of the urine in the inflammation makes the prognosis more serious, but recovery has taken place under the same therapeutic measures which are employed in pyelitis.