127 
and efficient nursing the prognosis can be regarded as excellent. 
Patients exhibiting a high degree or steady increase of album¬ 
inuria and a lessening in the amount of urine voided in the twenty- 
four hours are bound to have a severe struggle. So long as there is 
a fair quantity of urine passed, the amount of albumin per litre may be 
20 to 4'0 grammes. A grave prognosis is always given when the 
kidneys show signs of failure and the albumin is increasing. Albumin 
appearing in the first twenty-four hours is an extremely serious sign. 
The later the albumin appears in the urine, the better the prognosis. 
Anuria, if long continued, is invariably fatal. 
Marked jaundice on the second day indicates severe hepatic lesions, 
and merits a grave prognosis. The longer the appearance is delayed 
the more favourable the prognosis. Severe jaundice is generally 
associated with delirium ; it is usually the forerunner of haemorrhages, 
and if there is coincident failure of the urine or severe albuminuria 
the outlook is most gloomy. 
Haemorrhages. Epistaxis is a not unfavourable sign, and the 
patients appear markedly relieved after they have lost some fifty or 
more grammes of blood. It is quite common to meet \\ ith it as one o 
the prodromal symptoms. Severe and long continued epistaxis is to 
be feared. 
Bleeding from the gums is not unusual and is not dangerous, 
provided it only appears about the fourth to fifth day and is not 
excessive. An early appearance on the second or third day anc 
copious haemorrhages indicate a severe attack, and in all probability 
other haemorrhagic complications will occur. Copious haemorrhages 
from the inside of the cheeks and the tongue are prone to occur 
through the patient accidentally biting the tip or sides of the lattei 
the mucous membrane of the cheeks. 
Gastric haemorrhages are always an indication of a se\ere t)P e 
the fever. Black vomit occurring within the first two da)s o ti 
disease is of the very gravest import. Though it is always a a 
symptom and demands a guarded prognosis, patients whose ki > 
are acting well can develop black vomit on the fourth or fifth a) 
recover. The longer black vomit is delayed the better the prognosis 
Marked failure of tile renal system associated with this comp ic ^ 
is almost invariably fatal. Black vomit appearing in c . 
gums are already bleeding generally indicates a fata ten 
