specific gravity of the urine ranges from 1008° to 1012o, and always bears a direct relation to the quantity of the urine. When, however, the urine falls considerably in quantity, after the disappearance of the dropsy, there is a considerable rise in its specific gravity, and it regains its natural colour. The albuminuria, after the commencement of the treatment, becomes greatly diminished; there being both a relative and an absolute diminution of the albumen, and a progressive reduction continues, until it finally disappears from the urine. But in old standing cases a considerable period is frequently required to effect a serious reduction in the quantity, of the albumen. Under any circumstances the albuminaria is the last symptom to disappear; so that it sometimes continues, though in greatly reduced and diminishing quantity, for weeks or even months after the kidneys have apparently regained, in other respects, their healthy condition, and are performing their secreting function vigorously, and every other trace of the disease has disappeared. The persistence of this symptom under such circumstances, appears to me to be attributable to the long continued distention to which, in protracted chronic cases, the walls of the malpighian capillaries have been subjected; and

which has the effect of altering or impairing their delicate structure (which in the healthy state permits the escape of water only) to such a degree that a long period is necessary to enable them to regain their normal condition; so that, in the meantime, some albumen escapes with the water of the urine, even although every other structure of the organs may be perfectly healthy, and no impediment exist to their capillary circulation.

So soon as the diuretic action of the skim-milk is fairly established, the dropsy begins to subside and continues to decrease rapidly until it finally disappears; the time required for its complete removal being from five days to two or three weeks, or even more. In recent cases, and sometimes even in those of long duration, it vanishes with a rapidity truly astonishing; but generally in old standing, confirmed instances, a longer period is required, and a little swelling of the feet and ankles continues for a few weeks after the general anasarca and ascites have completely disappeared. No better illustrations could be given of the remarkable power of the skim-milk treatment over renal dropsy than Cases I. and III., to be recorded further on; in the latter case (that of W. M.), treated under my care in the Sunderland Infirmary, the dropsy was so

urgent as to threaten the immediate destruction of life; yet no less than 24 lbs. of dropsical fluid were removed in nine days. I shall, further on, refer to other examples equally conclusive. I may add, that so powerful is the action of the treatment in this respect, that in every instance which has come under my own observation, the dropsy has been removed, and although in some instances treated. at too late a period of the disease to insure recovery, or from indiscretions of the patient, the dropsy has reappeared to a greater or less extent, yet in not a single instance has it proved fatal or become uncontrollable.

From these observations it will be perceived that the effect of the skim-milk treatment, when timely applied, is to produce immediate and profuse diuresis, generally attended with diaphoresis, rapid removal of the dropsy, and, at first, a great diminution, followed by the gradual and complete disappearance, of the albuminuria. These important results are followed by recovery of the patient; the pale, pasty and puffy countenance gives way to a clear or ruddy complexion, accompanied with a restoration of health and strength. Consequently, the question naturally presents itself: to what influences are we to attribute such extremely important results

from a remedy which, to all appearances, is so exceedingly simple? Now, I shall endeavour to answer this question by giving the following explanation, based on the pathological conditions pertaining to the disease already described :—

The therapeutic action of skim-milk in Bright's disease is dependent on the morbid condition of the blood, which it restores to its normal condition. This is the initial change, from which all the others follow as consequent effects.

When a patient, suffering from this affection and severe general dropsy, and whose blood is reduced to the condition described in the preceding chapter (hydræmic, and its serum of a specific gravity of 1018° or 1020°, and far below the normal standard from the retention of water and the loss of albumen and salts, together with great destruction of red corpuscles), begins to consume daily from 6 to 8 pints of skim-milk-rich in albumen, easily assimilated, and the salts which the blood has lost, and having moreover a specific gravity of from 1035° to 1040° the greater portion of which is absorbed into the blood, the immediate and invariable effect is to restore the lost albumen and salts to the blood, and to raise the specific gravity of its serum to the natural standard, and greatly above that of the

dropsical fluid accumulated outside the vascular system.

Not only is the specific gravity of the blood serum increased by the accession of the solid matter, but the sudden influx of so large a quantity of fluid, greatly augments the volume of the blood, so that a plethora of the vascular system is produced. But this plethora cannot now be relieved by the transudation of a portion of the blood serum through the walls of the blood-vessels, so as to augment the dropsy, this being effectually prevented by the laws which regulate the force of osmosis, and the result is that the intra-vascular pressure, thus engendered, excites profuse diuresis, by which the tension of the vascular system is relieved. But as the large quantity of urine voided has a specific gravity of only 1008°, or 1012° at the outside, the withdrawal of so much water raises the density of the blood serum still higher, and endosmosis of the dropsical fluid, already begun, into the blood is established, and, as this continually progresses as the administration and absorption of skim-milk continues, a constant vascular plethora is maintained, and the profuse flow of urine becomes continuous. It will, therefore, be observed that the first effect of the skim-milk is to raise the density of the blood serum,