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The first one results oftentimes as a sequel of the acute form of Bright's disease; the second seems to occur from habitual excesses in eating and drinking. So frequently is this form of the disease found in those who are partial to the pleasures of the table, that this variety is often called the " gouty " form of Bright's disease, from its frequent occurrence in those who are subject to gout. Symptoms.-That form of Bright's disease which we frequently see as the result of an acute attack, is developed somewhat insidiously. In a large number of cases the attention is first attracted to the possibility of organic disease by the occurrence of dropsy. This dropsy begins as slight swelling of the feet, noticed usually at first only at the close of the day, after the patient has been actively engaged upon his feet for several hours. In other cases the individual becomes aware of a slight though unmistakable failure of the health, which manifests itself by an impairment of strength and by an unusual degree of pallor. In still other cases the first intimation of the disease comes in the shape of shortness of breath, noticed especially when the patient ascends stairs rapidly. In still other instances the vision becomes somewhat impaired ; and in many cases the patient has no suspicion of disease elsewhere than in the eye, until he consults an oculist, who, upon examining the eye with a mirror, discovers certain changes which direct his attention to the condition of the kidneys. In whatever way the disease begins, a certain group of symp toms manifest themselves after the lapse of a few months. First among these is dropsy. This begins, as has been stated, in the feet, and gradually proceeds up the limbs, until finally the entire body becomes swollen, sometimes to an enormous extent. The legs become so large that it seems impossible for the skin to hold them without bursting. After a time the body and limbs become so un manageable from the dropsical swelling that the patient is unable to walk. By this time there are usually some sores on the legs, and the skin is the seat of intolerable itching. The patient looks almost bloodless, except in the face, which is sometimes of a dark color, because the breathing has become so impaired that the blood is imperfectly aerated. In the course of time the digestive system also shows signs of derangement. The appetite becomes impaired, there is some indi gestion and even dyspepsia ; in many cases there is a constant ten dency to diarrhea and the formation of gas in the intestine. Later in the disease vomiting often occurs in a peculiar violent and sud den way, which has led to the employment of the term " explosive vomiting. " There are cases, indeed, in which these symptoms of impaired digestion occur before any other signs of kidney disease are apparent; in such cases the patient is sometimes treated for weeks or months for dyspepsia before the true source of the com plaint is discovered. The breathing, too, is impaired sooner or later in this disease ; sometimes by the accumulation of watery fluid-that is dropsy-in the cavity of the chest. This is especially apt to be the case if, as often occurs, there is also disease of the heart. This dropsy of the lungs is at times suddenly developed, and may then prove to be the cause of death. Dropsy of the larynx is also an occasional symp tom, and always a dangerous accident. Among the symptoms, too, are some which must be referred to the nervous system. Among these is obstinate and frequently recurring headache, attacks of dizziness, impairment of sight, and neuralgia in different parts of the body. These affections of the eyes frequently occur in the later stages of the disease. As the affection approaches a fatal termination, occasional transient delirium is not infrequently observed ; and for some days before death the patient frequently lies in a state of stupor, interrupted perhaps by occasional convulsions. These appearances show that uræmia is occurring - that the kidneys' have become so disorganized as to be incapable of performing their duty ; hence the urea accumulates in the blood and exerts its poisonous effects upon the brain. Some times uræmia, stupor, convulsions and death occur suddenly before the other symptoms have become pronounced, and while the dropsy is still slight in quantity. In fact, there are instances, though not very numerous, in which the patient dies suddenly in convulsions, although no suspicion of kidney disease had been entertained. These cases occur more frequently in the other form of chronic Bright's disease, the " gouty" form, to be presently described. The urine also exhibits characteristic changes during this form of Bright's disease ; it becomes diminished in quantity and deposits a heavy sediment, as a rule. This urine contains albumen, and the sediment exhibits certain delicate structures derived from the kidney and termed tube casts. These are to be discovered only by the use of the microscope ; indeed, it is impossible to make a posi tive diagnosis in the early stages of this disease without a careful chemical and microscopical examination of the urine. It should, however, be said, for the comfort and benefit of numerous individ uals, that the presence of albumen alone in the urine does not, necessarily, prove the existence of Bright's disease. This remark is emphasized, because the writer has been so often consulted by individuals in whose urine albumen has been discovered, and upon whom the dreadful sentence, " Bright's disease," had been pro nounced. There are numerous other causes which may induce the presence of albumen in the urine ; and until the symptoms have become pronounced, until the dropsy, emaciation and loss of strength are unmistakable, no one, not even a physician, can be sure of the existence of Bright's disease without a most careful micro scopical examination of the urine. It is the popular impression, that to be afflicted with Bright's disease is equivalent to receiving a sentence of death. It must be confessed that in most, perhaps all, of those cases in which the symptoms above described are pronounced and of long standing; in which the dropsy has become extensive, and in which the symptoms of digestive disturbances and of nervous disorders are apparent-in such cases it is doubtless true that recovery rarely, if ever, occurs. But it must be remembered that Bright's disease is usually far advanced when it has resulted in the production of these symptoms. There is an earlier stage of the disease, lasting months at least, in which the affection is not fully recognized, nor perhaps even suspected ; and it is equally certain that recovery does some times occur from this early stage. This is proven by the records of cases in which the disease has been detected at an early period by especially skillful physicians, and has been cured by them ; and has been equally well demonstrated by postmortem examinations of persons who, at the time of death, had no Bright's disease, and yet whose kidneys showed undisputable evidence that such disease had previously existed. Treatment.-In the vast majority of cases the disease is not recognized until it is too late to expect recovery under any plan of treatment ; yet the sufferings of the patient can be decidedly mitigated, and indeed his life prolonged, by attention to certain measures. Among the most important of these is the observance of proper sanitary regulations. The patient should carefully avoid exposure to wet and cold ; should not undergo physical or mental fatigue ; should avoid excesses at the table or otherwise. The diet should contain but little meat, and may consist largely of milk, eggs, fruits and vegetables. The clothing may be warm, flannel being worn next to the skin. Among medicines most good will be derived from iron, which may be given in that form that the patient finds most agreeable. Sometimes some little care and experimenting are necessary in order to discover the particular form of iron which can be best borne. In some cases the tincture of the chloride of iron in doses of from ten to fifteen drops, taken before meals, will agree with the patient's stomach. Others again will be best satisfied with the citrate of iron, five grains of which may be given three times a day ; still other cases will be most benefited by the syrup of the iodide of iron, though the syrup in this preparation is apt to disa gree with the stomach. Cod liver oil will also be found of use in strengthening the patient ; few persons suffering from this disease will be able to take the article in its crude form ; it will generally be found necessary to give it in the shape of an emulsion, many of which can be found at the drug stores. The dropsy usually requires treatment quite early in the dis eas'e. To reduce it, the bowrels may be kept active by means of saline laxatives, with or without jalap powder, as described in dis cussing the subject of dropsy. But it must be repeated, that it is possible to exhaust the patient materially by the over-zealous use of cathartics for the purpose of reducing the dropsy. Another measure is the hot air bath, or the hot vapor bath, which may be used with less detriment to the patient. And finally cases occur in which the abdomen must be tapped to remove the water, and, perhaps, slight incisions made in the legs in order to permit the fluid to drain away. The other form of chronic Bright's disease, that to which ref erence has already been made, under the name of the " gouty " variety, differs from that form just described in many essential particulars. It is one of the most insidious and gradual diseases with which we are acquainted. It has been known to exist in an individual for ten, fifteen or even twenty years before reaching a fatal termination. Symptoms.-As to the symptoms whicn accompany the oeginning of the disease, it is almost impossible to give any descrip tion, because the onset is so slow and insidious that it is rarely discovered until it has evidently existed for a considerable time. In this form of the disease there is rarely any dropsy until v/ithin a very short period before death, and even then it occurs only in exceptional cases. The patient is usually led to seek med ical advice for some symptom which has but little if any relation with the kidney. In one case the difficulty complained of will be impairment of vision ; in another, obstinate and violent headache ; in the third the patient will seem to suffer from dyspepsia ; in others again there will be palpitation of the heart. In many cases attention is first drawn to the difficulty by the excessive secretion of urine, several quarts of which may be passed in twenty-four hours, compelling the patient to arise at night in order to evacuate his bladder. The patient's general health may remain unimpaired for years, and he may in fact have no suspicion that serious organic disease exists. These are the cases which are so often discovered unex- pectedly during examinations for life insurance, or upon other critical medical inspection, since such individuals often suppose themselves to be and really seem to be in perfect health. As the disease advances, several troublesome symptoms are apt to occur. Foremost among these is the frequency of urination, for in this disease there is an excessive amount of urine passexl. The patient is compelled to evacuate the bladder frequently, often times by night as well as by day ; yet the act is not accompanied by pain, but is natural in every respect. The urine passed is clear, often somewhat lighter colored than natural, but contains no sedi ment. After the affection of the kidneys has endured for some time, there occurs in the majority of cases an enlargement of the heart. In fact, there are numerous instances in which this change in the heart seems to occur almost or quite as early as the disease in the kidney. This enlargement of the heart causes a feeling of weight and fullness in the chest, often accompanied by fits of palpitation ; the pulse at the wrist becomes very hard, almost resembling an iron wire ; there is apt to be painful throbbing of the vessels of the neck and head. This feature is a most important part of this form of chronic Bright's disease, because many of the symptoms characteristic of the disease, and many of the sudden deaths from so-called " apoplexy," are really due to the enlargement of the heart which accompanies this inflammation of the kidneys. In the majority of cases this form of Bright's disease occurs in advanced life, and is especially frequent, though by no means con fined to those who are especially prone to over-indulgence in eating and drinking. Many of the sudden deaths which occur in men of full habit, with thick necks and rotund forms, are due to apoplexy, that is to a bursting of blood vessels within the brain. Now this rupture of the vessels is in many cases due to the excessive force of the blood current, which is propelled by a heart of unusual size and power. In fact the immediate danger in these cases of Bright's disease is from a rupture of blood vessels, since the disease of the kidney itself rarely causes a fatal result except after several years of existence. Another feature sometimes observed in this form of Bright's disease is a slow poisoning by the accumulation of urea in the blood-chronic uræntia, as it is technically called. The symp toms which indicate uræmia in acute Bright's disease have been already described ; these consist of violent and severe vomiting and purging, excessive perspiration, delirium, stupor and convulsions. In chronic uræmia similar symptoms may be present though in a less intense degree, so that in some instances no suspicion of the real cause of the difficulty exists. In these cases the patient is apt to have chilly sensations or even pronounced chills, followed by fever and perspirations ; there may be some inclination to vomit and an obstinate diarrhea. Cases are recorded in which the patient had been treated for some time for malarial fever when he was really suffering from chronic uræmia and Bright's disease ; the mistake arose from the occurrence of chills and fever every day or two, strongly suggestive of ague. In other instances again a chronic diarrhea of long standing has been found to be due to Bright's disease of the kidneys. In still other instances the attempt to eliminate the urea seems to fall largely upon the lungs, resulting in a persistent bronchitis, often associated with asthma. In fact, after the attention of the physician has once been called to the diversity of symptoms by which this form of chronic Bright's disease may manifest itself, he is always watchful for its existence in middle-aged or elderly people, especially in those who are troubled with chronic affections of the alimentary canal, of the lungs, or of the heart. Yet while the majority of cases are detected in people who have attained or have passed middle age, the disease may occur in youth or even in childhood. Treatment.--There is no plan or treatment known whereby this form of Bright's disease can be cured or even arrested. That recovery does sometimes occur admits of no question ; yet it is by no means established that such recoveries are due to the treatment pursued and not to other influences of which we have no con ception. It seems quite certain that by avoiding those articles of food the consumption of which throws extra work upon the kidneys, wre may, to a certain extent, give these organs a rest, and thus put them in the best possible condition for recovery. Such articles include, generally speaking, meats and animal food, and alcoholic stimulants. It is, therefore, advisable to restrict the diet of the patient with regard to these articles of food ; he should be encour aged to live largely upon milk and eggs, indulging his appetite for fruits and vegetables, as he may please. Beyond this we cannot go in our efforts to improve the condition of the kidneys. Yet there is often a considerable field for medicines in the treatment of this complaint. The safety and welfare of the patient depend upon the maintenance of an excessive secretion of urine ; so long as the heart is sufficiently powerful to force the blood through the kidneys, the secretion continues. But there often occur times when the heart seems unable to accomplish this work without assistance ; this assistance can be rendered by the use of digitalis. Another important item is the avoidance of sudden and ex cessive physical effort or mental emotion. For it is frequently by some such effort or emotion that an attack of apoplexy is provoked. Care should be taken that there be no unnecessary exposure to cold or wet, since aggravations of the disease are thereby induced. It is the fashion nowadays for patients with kidney disease to resort to mineral springs, many of which are well advertised as cures for Bright's disease, and in fact almost all complaints of the urinary organs. There can be no question of the benefit derived by many sufferers from Bright's disease from visits at these springs. It is equally certain that the benefit thus derived is not to be ascribed in the minutest degree to any virtues possessed by the waters, but is due wholly and entirely to the invigorating effect which follows the change of life and scenery and occupation incident to a residence at these watering places. There is absolutely no remedy, whether in the shape of drug or mineral w'ater, which has ever been known to exert the slightest influence in arresting those changes in the kidney constituting Bright's disease. Yet this remark is not intended to decry in any way the value of a sojourn at one of these popular resorts; for everything which can con tribute to the comfort and enjoyment of the patient has a beneficial effect, not by arresting the disease, but by invigorating the patient, so that he can resist its ravages with better effect and for a longer time. In some forms of Bright's disease residence at one of these springs has an additional advantage, namely, that the patient is thereby induced to drink more water than he otherwise would. It is not to be laid down as a general principle that to drink an excess of water has a beneficial effect. It is the popular idea that impuri ties can be washed out of the human body by an abundance of water, just as filth can be "flushed" out of sewers by flooding these channels. Such a conception can of course exist only where the most child- like innocence of human physiology prevails. Were tne body merely a system of sewers, benefit might always be expected from rinsing the sewers with an abundance of water ; but under the present con struction of the human body the maintenance of health is a matter by no means so simple. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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