14- DISEASES OF THE KIDNEY. 



character of the acute croupous nephritis (acute Bright's disease) 

 runs into that of chronic diffuse nephritis (chronic Bright's dis- 

 ease). I have never seen such a case, and they must be very rare. 



TREATMENT. In recent cases, and in tolerably robust subjects, 

 it is advisable to resort to local depletion over the region of the kid- 

 neys, by means of leeches or cups. The effect of the first applica- 

 tion will decide as to the propriety of its repetition in case of recur- 

 rence of the symptoms. General blood-letting should be rejected, 

 as liable to aggravate the already existing tendency to deterioration 

 of the blood. The use of calomel and other so-called antiphlogistics 

 is equally improper. Warm baths, followed by envelopment of the 

 body in woollen blankets, are much preferable to the internal ex- 

 hibition of diaphoretics. In treating of chronic Bright's disease, 

 we shall go more into detail upon this subject, and upon the brilliant 

 results which are sometimes obtained from diaphoresis. If the bow- 

 els be confined, a few powerful doses of drastic medicine should be 

 given jalap, senna, or even colocynth. The profuse serous tran- 

 sudation into the intestine caused by these medicines may have a 

 beneficial effect upon the dropsy ; but it sometimes happens that the 

 patient has a violent diarrhea, and yet the dropsy continues to in- 

 crease rapidly. Mineral waters containing carbonic acid are the most 

 suitable beverage. We should not be too sparing in their adminis- 

 tration, as the increase of pressure in the glomeruli, and the aug- 

 mented transudation, may assist in washing away the obstructing 

 coagula. On the other hand, drastic diuretics are contraindicated, 

 owing to the inflamed condition of the kidney. During convales- 

 cence, and in tedious cases even prior to convalescence, the ten- 

 dency to deterioration of the blood must be combated by the 

 administration of quinine and iron, and a plentiful supply of albu- 

 minous food. 



CHAPTER IV. 



CHRONIC DIFFUSE NEPHRITIS CHRONIC BRIGHT'S DISEASE. 



[PATHOLOGY AND ETIOLOGY. The following synopsis may serve 

 to give the reader an insight into the present state of knowledge 

 regarding Bright's disease. We have long made use of Frerichs's 

 classification of the anatomical stages of the disease : 1st, the stage 

 of hyperaemia ; 2d, that of exudation and of commencing conversion 

 of the exudation , 3d, the stage of retrogression and atrophy. But 

 it has been found that the first of these conditions properly belongs 

 only to acute diffuse nephritis ; so that for chronic nephritis there 



