The treatment of these conditions consists in absolute rest, diet of the simplest sort, pref erably milk, opening of the various emtinc tones (the bowels and skin) and attending to such symptoms as threaten the life of the patient.
Chronic Bright's, Chronic Nephritk—This disorder is characterized by ,a permanent change in the tissue of the kidney, which may follow acute inflammation, or may come on insidiously as a result of poisoning by alcohol, of syphilis, of prolonged nervous strain, with consequent disturbance of digestion and metabolism, of suppurative inflammations in other parts of the body and of many undiscoverable causes. The changes in the kidneys consist in growth of connective tissue around the glomeruli and tu bules, more or less degeneration of the epithe lium lining the tubes, and arteritis. The dis ease may be very insidious in development, al bumen and casts being discovered on routine examination of the urine. Loss of nutrition may be noticed, or a disturbance of the gastro intestinal tract may first call attention to the disease. The urine may be increased in amount or diminished, but as the disease progresses the specific gravity grows less from the decrease of urea. Dropsy appears around the ankles and spreads usually as the disease advances. Anx mia is fairly constant, but not severe. Sooner or later that general condition of poisoning known as urminia is apt to develop because of the inability of the kidneys to excrete the toxic substances. Some cases suddenly develop one or more of the various symptoms, either dys pncea, dropsy, failure of the heart's action, coma, convulsions or hemiplegia, without the nephritis having occasioned distinct symptoms previously.
Prognosis in Chronic The prognosis is not necessarily bad, although as a rule the disease progresses and causes the death of the patient. Intercurrent diseases throw extra strain on the kidneys and may hasten a fatal termination. Many cases live for years in comparative health and are carried off by another affection. The actual prognosis of a case is determined by the work the kidneys are able to do on a known diet and under stated conditions of work. This is best determined
by an estimation of the excretion of urea in a 24-hour collection of urine.
Many things can be done for a chronic nephritis. In the first place it should be remembered that the work done by the kid neys is really enormous. Millions of foot pounds of energy are utilized in kidney. func tioning. Then again it should be recalled that although the term chronic nephritis is a single term, it stands not for one disease, but for a large group of diseases, many of them quite different in causation. Some of these are dif ficult to treat, others are very fruitful in treat ment. The group due to definite irritants, such as alcohol or syphilis, can be handled by getting at the causes of the alcoholism — which are usually mental — and thus relieving the double effect of mental strain and chemical poisoning. The syphilitic cases need proper medicinal treatment. The whole group of hyperadrenale mianephritides, often on a mental basis, are particularly favorable to treatment by compe tent psychoanalysis. Such analysis can be per formed only by a well-trained physician ac quainted with the dynamics of the kidney func tion. Consult Cushney, 'The Secretion of Urine' (1917). Other types of chronic nephri tis are as yet unanalyzed. They usually progress but are held in check largely by diet and hy giene. There are many ups and downs in the course of the various nephritides.
At the time of acute exacerbations symp toms are relieved as they arise and the skin and bowels are called upon to assist The kid neys in the work of excretion by diaphoresis (by the hot pack) and catharsis. When the out put of urine becomes small, some benefit may result from the administration of diuretics. For the disturbance of the circulation arterial dilators and cardiac stimulants are employed, and sometimes bloodletting, with the greatest benefits.
Renal Calculi or Kidney-Stones.— See