This disease is no different from acute Bright's disease, except that the patient has shown a strong resistance, and has also been incorrigible, inasmuch as when better he has been imprudent. Those who have once had an attack of Bright's disease, and were fortunate enough to overcome it, should be very willing to live moderately and take the proper care of themselves. Many people die of Bright's disease because they prefer a short and merry life, to a longer one if subjected to what they call restrictions and privations.

Symptoms

Acute nephritis has been showing itself occasionally for some time--perhaps slight attacks a few months apart. The chronic form may start up in a very insidious way, following badly treated acute fevers, indigestion, or a general breaking-down from any cause. A patient will have a period of depression, followed by swelling of feet and ankles. There are usually pallor and puffiness about the eyelids. The feet become more and more swollen of an evening, and later of a morning. This is not true in the swelling that follows a weakened condition of the system from overwork; for then the feet are swollen at night, and there is no swelling at all in the morning. The urine is usually scanty and has a yellowish, cloudy appearance. On account of the urates, it is usually cloudy. On standing, a sediment settles to the bottom. When the urine is heated to the boiling-point, the cloudiness will increase. Then, by adding a drop or two of lemon juice or two or three drops of acid, the phosphates will clear. If there is albumin in the urine, it will not clear. A very ugly-appearing urine is passed by patients who have a great deal of uric acid in the system and who pass large quantities of phosphates and urates. The urine will look very heavy, and there will be red, sandy particles settling to the bottom. Often this urine will clear up as nicely as any urine can by simply warming it. This indicates that the patient is eating altogether too much of the staple foods, and not enough of the fruits and vegetables. A day or two on fruit will clear such urine. Perhaps one meal of fruit will do so. But in Bright's disease the urine, when heated, will coagulate, so to speak. Where there is a great deal of albumin in the urine, it will congeal to such an extent that it cannot be poured out of the test-tube. Such cases as this are very rare, however. When acid is added to albuminous urine, the albumin is not cleared up; it remains as the heat has left it.

The specific gravity of the urine in the early stages is from 1.020 to 1.025, sometimes even going as high as 1.040. In the last stages the specific gravity is low. The quantity is always reduced. One of the most pronounced symptoms of Bright's disease is drowsiness.

Treatment

The treatment need not be any different from that recommended for acute Bright's disease.