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Bright's Disease

BRIGHT'S DISEASE, a term in medicine applied to a class of diseases of the kidneys which have as their most pro-minent symptom the presence of albumen in the urine, and frequently also the co-existence of dropsy. These associ-ated symptoms in connection with kidney disease were first described in 1827 by Dr Richard Bright. Since that period the subject has been investigated by many able physicians, and it is now well established that the symptoms above named, instead of being as was formerly supposed the result of one form of disease of the kidneys, may be depend-ent on various morbid conditions of those organs. Hence the term Bright's disease, which is retained in medical nomenclature in honour of Dr Bright, must be understood as having a generic application.

Two varieties of Bright's disease are described, the acute and the chronic,—the former representing the inflammatory and the latter the degenerative form of kidney disease.

Acute Bright's Disease (synonyms—acute desquamative nephritis, acute albuminuria, &c.) commonly arises from exposure to cold, from intemperance, or as a complication of certain acute diseases, such as .erysipelas, diphtheria, and especially scarlet fever, of which it is one of the most frequent and serious consequences. In this form of the disease the kidneys become congested, their blood-vessels being gorged with blood, while the tubules are distended and obstructed by accumulated epithelium, as also by effused blood and the products of inflammation, all which are shed off and appear in the urine on microscopic examina-tion as casts of the uriniferous tubes.

The symptoms to which the condition gives rise are usually of a severe character. Pain in the back, vomiting, and febrile disturbance commonly usher in the attack. Dropsy, varying in degree from slight puffiness of the face to an accumulation of fluid sufficient to distend the whole body, and to occasion serious embarrassment to respiration, is a very common accompaniment. The urine is reduced in quantity, is of dark, smoky, or bloody colour, and exhibits to chemical reaction the presence of a large amount of albumen, while, under the microscope, blood corpuscles and casts, as above mentioned, are found in abundance.

This state of acute inflammation may by its severity destroy life, or, short of this, may by continuance result in the establishment of one of the chronic forms of Bright's disease. On the other hand an arrest of the inflammatory action frequently occurs, and this is marked by the increased amount of the urine, and the gradual disappearance of its albumen and other abnormal constituents ; as also by the subsidence of the dropsy and the rapid recovery of strength.

Of chronic Bright's Disease there are several forms, named according to the structural changes undergone by the kidneys. The most frequent of these is the large white kidney, which is the chronic form of the desquamative nephritis above mentioned.

Another form of chronic Bright's disease is the waxy or amyloid kidney, due to the degenerative change which affects first the blood-vessels and subsequently also the tubular structures of the organ. This condition is usually found associated with some chronic ailment of an exhausting character, such as disease of bones and other scrofulous affections, or with a generally enfeebled state of health. It is marked by the passage of large quantities of albuminous urine, and is frequently accom-panied with general dropsy, as also with diarrhoea and consequent loss of strength. A third form of chronic Bright's disease is the contracted kidney, depending on the condition known as cirrhosis, in which the kidneys become re-duced in bulk, but dense in texture, from an abnormal development of their connective tissue and relative atrophy of their true structure. This form of the disease, which is commonly, though not exclusively connected with a gouty constitution, is apt to escape detection in its earlier stages from the more obscure character of the symptoms, there being less albuminuria and less dropsy than in the other varieties. Its later progress, however, enables it to be readily recognized. Dimness of vision, due to a morbid con-dition of the retina, and also hypertrophy of the heart leading to fatal apoplexy, are frequent accompaniments of this form of the disease.

A fourth variety of chronic Bright's disease is described by authors on the subject, viz., fatty degeneration of the kidneys, occasionally occurring in old age and in connection with a similar degeneration of other organs.

The kidneys being among the most important excretory organs of the body, it follows that when their function is interrupted, as it is alike in acute and chronic Bright's disease, serious results are apt to arise from the retention in the economy of those effete matters which it is the office of the kidneys to eliminate. The blood being thus con-taminated, and at the same time impoverished by the draining away of its albumen from the kidneys, is rendered unfit to carry on the processes of healthy nutrition ; and, as a consequence, various secondary diseases are liable to be induced. Inflammatory affections within the chest are of frequent occurrence, but the most dangerous of all the complications of Bright's disease are the nervous symp-toms which may arise at any stage, and which are ascribed to the effects of ursemic poisoning.

In the treatment of acute Bright's disease, good results are often obtained from local depletion, from warm baths, and from the careful employment of diuretics and purgatives. Chronic Bright's disease is much less amenable to treat-ment, but by efforts to maintain the strength and improve the quality of the blood by strong nourishment, and at the same time by guarding against the risks of complica-tions, life may often be prolonged in comparative comfort, and even a certain measure of improvement be experienced.

See Report on Medical Cases, by Richard Bright, London, 1827 ; On Granular Degeneration of the Kidneys, by Robert Christison, M.D., Edinburgh, 1839 ; Diseases of the Kidney, by Dr G. Johnson, London, 1866 ; Practical Treatise on Urinary and Renal Diseases, by Wm. Roberts, M.D., London, 1865 ; On the Pathology and Treatment of Albuminuria, by W. H. Dickinson, M.D., London, 1868 ; Practical Treatise on Bright's Diseases of the Kidneys, by T. Grainger Stewart, M.D., Edin. 1871. (J. O. A.)

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