CHRONIC BRIGHT'S DISEASE. 33 



ago. We have already alluded to the fluctuations in the intensity 

 of the symptoms which take place in protracted cases. The most 

 frequent termination of Bright's disease is death ; although patients 

 more commonly die of the intercurrent inflammations than directly 

 of the disease itself. Complete recovery may possibly take place, 

 but it is extraordinarily rare. The longer the duration of the mal- 

 ady, so much the less is a favorable result to be looked for. In re- 

 cent cases, the question always arises whether we have not to do 

 with a croupous nephritis, which, as we have explained, admits of a 

 better prognosis. 



TREATMENT. The causal indications require that a patient with 

 parenchymatous nephritis should wear flannel next his skin, and ex- 

 change his dwelling, if damp and cold, for a dry and warm one ; and 

 that he should be forbidden to go out at night or in bad weather, 

 even during any temporary improvement. Well-to-do people, who 

 dwell in bleak, damp, windy, seaside neighborhoods, should be in- 

 duced to change theif abode. Excesses in spirituous liquors, and 

 the Use of "diuretics, cubebs, copaiba, and spices, are to be strictly 

 prohibited. The discovery that Bright's disease is an inflamma- 

 tory affection has done but little toward an efficient treatment of 

 it. The so-called antiphlogistic method is inapplicable to any of 

 its stages. 



[The practice of blood-letting, the application of cold com- 

 presses, and the use of calomel no longer find advocates. We 

 possess no means of extinguishing this obstinate and refractory 

 disorder. Our task is therefore by no means simple, nor can any 

 uniform plan of management be adopted for. all cases. Its treat- 

 ment must be chiefly a treatment of symptoms. The main disor- 

 der can only be attacked indirectly, by seeking to combat the indi- 

 vidual pernicious or dangerous manifestations as they arise, and by 

 striving to remove all influences tending to irritate the kidneys. 

 From this point of view the scope and value of therapeutics in 

 the varying phases of Bright's disease, as tending to prolong the 

 life and to ameliorate the condition of the sufferer, should not be 

 underrated.] 



In fulfilment of the indications from the disease itself, derivation 

 from the intestines by drastics, and from the skin by diaphoretics, 

 has been proposed. We shall recur to the employment of this 

 measure while treating of the management of the symptoms, as it 

 often acts favorably upon the dropsy ; but we do not believe that the 

 inflammation of the kidney can be arrested or allayed by such deri- 

 vation. Frerichs speaks favorably of tannic acid, which he gives 

 three times daily, in doses of from two to six grains, in combination 



