an acute and severe form (seldom advancing beyond the first stage), by the poison of scarlet fever, while cases, subacute or chronic at the outset, as a very general rule, originate from exposure to cold or wet. Acute cases, too, are engendered by the same cause. The common history of the disease in adults is, that its symptoms make their appearance shortly after exposure to wet or cold. The vast majority of such cases owe their origin to no other detectable cause. These facts strongly indicate that the materies morbi or poison is of a character which gives it a strong tendency to be eliminated by the skin.

The disease is much more frequent in males than in females, and in adults of both sexes than in children. The greater proneness of men being due to their occupations and habits, which expose them more to vicissitudes of temperature, and to indulgence in eating and drinking, which, especially if associated with sedentary habits, engenders blood impurities, giving a strong proclivity to visceral inflammations on exposure to cold or damp. When Bright's disease becomes developed in children, it is generally the sequence of the renal inflammation following scarlet fever.

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CHAPTER XIII.

THE SKIM-MILK TREATMENT OF BRIGHT'S DISEASE.

FROM the description given in the preceding chapter, it will be observed that the species of renal affection which is, properly speaking, Bright's disease— beginning in an inflammatory condition, acute or chronic, passing into fatty degeneration and enlargement of the kidneys, and in which a scanty, highly albuminous condition of the urine associated with dropsy, more or less general, are prominent symptoms-is, in cases not casually complicated, essentially a primary affection and not, like the other forms of so-called Bright's disease, consequent on and the result of previously existing, chronic, wasting maladies or cachexias. It is on account of this specific difference, that it is much more amenable to treatment than any of these other forms: even although known to be a very intractable and fatal malady. It is, moreover, in this species of renal affection that I have prescribed the Skim-milk Treatment with such remarkable success. A success which, to say the

least, has convinced me that when the disease has lasted a considerable period, and assumed its confirmed chronic condition with a gradual increase of its symptoms in spite of remedial measures, this is the only treatment on which any reliance can be placed, or which offers a reasonable chance of recovery. Not only is this so, but I consider myself justified, by an experience now extending over a large number of cases in every stage, in stating that the disease can be cured in the vast majority of instances, provided the treatment has not been delayed until the third stage of atrophy, or of irreparable destruction of the kidneys has begun. But even then much good can be done and much suffering alleviated. I have now seen cures effected under such desperate and apparently hopeless circumstances, that I will even go the length of unhesitatingly stating that in the skim-milk treatment of Bright's disease, rigidly and properly administered, we possess a remedy of such extreme potency, that almost every uncomplicated case can be cured, if the treatment is commenced even so late as the early period of the second stage and the constitution of the patient is moderately good; and this is almost equivalent to declaring that scarcely any one should die of this affection, inasmuch as its symptoms are always palpably

manifest, and indeed frequently so severe, that death, by dropsy and other conspicuous causes ensues, before the first stage is far advanced. Consequently, there is not the same valid excuse for not beginning an efficient method of treatment sufficiently early to insure recovery, as there is in several other affections whose symptoms are at first so equivocal and obscure as to escape detection until it is too late to save life. It must not be inferred from what I have just stated, that a cure will not be effected at even a later period of the disease. I have seen cases recover in which the second stage was undoubtedly far advanced; but of course the chances of recovery diminish in proportion to the duration of this stage of fatty degeneration, and when irreparable destruction of the kidneys, or atrophy, is established it would be folly to say that the disease can be cured.

When a patient suffering from this disease associated with severe general dropsy and highly albuminous, scanty urine, and whose pale, pasty, anæmic countenance betrays too surely the extent to which his blood has been thinned and deprived of its essential and highly vitalised constituents, is placed under the skim-milk treatment, and its curative action is the result, the following are the changes which are effected.

In the first place, a powerful diuretic action is produced, so that in the course of a few hours there is a considerably increased discharge of urine, which continues augmenting until at the end of the second or third day, when a quantity is voided as large or even larger than that of the milk consumed, so that if 6 pints of skim-milk are taken during the twenty-four hours, the quantity of urine passed during the same period will range from 6 to 8 pints, or even more; and I may mention that, as a general rule, the more intense the dropsy the greater the diuretic effect 'produced, and the greater the excess of urine over the quantity of skim-milk ingested. This profuse diuresis continues until the dropsy has nearly subsided, when it gradually diminishes until the latter has disappeared, when the daily quantity of urine falls to about 1 or 2 pints below the daily allowance of skim-milk; and this relation between the two fluids continues from day to day so long as the skim-milk treatment is strictly adhered to. It is necessary to observe, that the surplus water of the skim-milk is accounted for by the quantity daily exhaled by the lungs and skin. Diaphoresis to a greater or less degree is the usual accompaniment of the increased flow of urine.

During the diuretic action of the treatment the