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In the course of clinical work with patients suffering from Bright's disease certain questions constantly present themselves which as constantly are left unanswered except by practical decisions of an almost completely arbitrary nature. For instance, how long should a patient be kept in bed when the initial stage of haemorrhagic Bright's disease has passed, when the edema has gone and the blood pressure has returned to its usual level? Certainly until examinations of the urinary sediment indicate a subsidence in the first intensity of the inflammatory process in the kidney, but also quite certainly not until all signs of inflammation have disappeared, since the latent stage of the disease extends over months or years or decades and during all this time the urine indicates the continuance of an active renal inflammation. If a pronounced increase in the number of casts, red blood cells and white blood cells and epithelial cells were observed after the patient was first out of bed, we might feel fairly certain that further rest was necessary, but it is impossible to interpret the significance of a moderate or slight increase. We know nothing about the response of the normal kidney to like conditions. It may be that some degree of increase in casts and red blood cells is the natural reaction of the kidney to the slight jars and jolts which it receives with every movement of the body. Again, in-the treatment of the actively inflammatory types of Bright's disease it has for long been the custom to reduce the quantity of protein in,

the journal of clinical investigation/the journal of clinical investigation

THE EFFECT OF SOME PHYSIOLOGICAL VARIABLES ON THE NUMBER OF CASTS, RED BLOOD CELLS AND WHITE BLOOD CELLS AND EPITHELIAL CELLS IN THE URINE OF NORMAL INDIVIDUALS *