Chronic N^ephritis. 239 



white, fibrous mass. Abscess of the kidne}' is exceptionally met 

 with (Laurent, L,afosse). 



Lesions of distant organs are not uncommon. Bronchitis, 

 pneumonia, pleurisy, insufficiency of the tricuspid or mitral 

 valves, dilated heart, hypertropliied or fatty heart, congested or 

 fibroid liver, arteritis, and dropsies are among such morbid con- 

 ditions. 



Prognosis. This is almost always unfavorable. Death may be 

 delayed for months or years, and partial transient recoveries may 

 take place but a restoration to normal structure and function is 

 not to be looked for. 



Treatment. This cannot be expected to be much more than 

 palliative. The avoidance of overwork, and of the exposure to 

 cold and wet, and the securing of a free action of the skin hy 

 warm buildings and clothing, are essential. The diet should be 

 easily digested and non-stimulating, for herbivora green food, car- 

 rots, roc'ts, apples, silage, with a moderate allowance of oats to 

 counteract weakne.ss and anaemia ; and iov carnivora , milk, butter- 

 milk, mu.sh made of oat, wheat or barley meal, with, if necessary, 

 a slight allowance of tender raw meat. Tonics fill a similar need. 

 Iron and bitters may be combined. Or hydrochloric acid or nitro- 

 muriatic acid with bitters (nux, calumba, salicin, quassia) may 

 be tried. These acids are especially valuable when the ca.se has 

 originated in or is maintained b}' calculi, indigestion or hepatic 

 disorder. When the heart is defective in tone, it may be stimu- 

 lated by small doses of digitalis, strophanthus, .spartein, caffein, 

 or nitro-glycerine, or to a certain extent by strychnia or nux. 

 These, however, must be used with judgment, if it is found that 

 they aggravate the case by increasing the arterial tension. In 

 those cases in which there is an excessive secretion of watery 

 urine, the possible source of this in musty aliment should be 

 avoided, and the flow checked by nux vomica, in moderate doses, 

 and bromide or iodide of potassium in full doses. When, on the 

 other hand, the urine becomes scanty and dense, the great danger 

 of a toxic action must be met by agents that favor excretion. 

 Pure water at will is perhaps the least objectionable of such 

 agents, but potassium or sodium acetate or citrate, or even sodium 

 chloride, in weak solution, may be given. In some cases benefit 

 will come from a moderate use of the balsam of copiaba, or the 



