ACUTE BRIGHT'S DISEASE. H 



epidemics they are of a hyperaemic nature, and give rise to the welt- 

 known symptoms of catarrhal angina in the throat, and in the kidneys 

 cause renal catarrh, as described in the foregoing chapter. There are 

 malignant epidemics of scarlatina, however, which give rise to much 

 graver disorder of these organs. Instead of simple catarrh, there is 

 nearly always a diphtheritic inflammation of the fauces, and, instead 

 of a simple renal hypersemia, the urinary tubules are attacked by 

 croupous inflammation. In such epidemics, many children die of 

 dropsy who have received the best possible care, while many, who 

 have been actually neglected, escape unscathed. The virus of measles, 

 typhus fever, and the poison of malaria, may also induce croupous 

 aephritis, but they are far less frequent causes of the disease than is 

 scarlatina. 



2. Acute Bright's disease arises during the typhoid stage of chol- 

 era, and by many is regarded as a constant complication, if not 

 the actual cause, of this very common and obscure sequel of cholera. 

 Although we cannot subscribe to this latter opinion, having witnessed 

 the- death' "of many patients from cholera typhoid, whose urine was 

 abundant and free from albumen, yet the frequence of croupous ne- 

 phritis, as a sequel to cholera, cannot be denied. It remains an open 

 question whether the vascular engorgement and inspissation of the 

 blood, which take place in the algid stages of cholera, induce obstruc- 

 tion of the renal capillaries from crowding together of the blood-cor- 

 puscles, and extravasation of plasma and blood into the tubules, or 

 whether the inflammation of the kidneys, like the other inflammatory 

 affections of the typhoid stage of cholera, be ascribable to infection 

 of the blood. It, undoubtedly, is very rare for croupous nephritis, in 

 healthy subjects, to proceed from contusions, the misuse of irritating 

 diuretics, exposure to cold, or other unknown exciting causes. 



ANATOMICAL APPEARANCES. The anatomical alterations found 

 post mortem after croupous nephritis are identical with those so ad- 

 mirably described by Frerichs as the first stage of Bright's disease, 

 the "stage of hypersemia and incipient exudation." The kidney is 

 often enlarged to twice its proper size, and its surface is smooth. The 

 tunica albuginea is opaque, injected, and is easily detached. The 

 cortical substance, to whose swelling the increase in volume of the 

 kidney is mainly due, is of a more or less dark-brown color, soft, and 

 easily torn. When cut into, a bloody adhesive liquid bathes the face 

 of the section. Both the superficial and deeper parts of the cortical 

 substance are dotted with dark-red points. The pyramids also are hy- 

 persemic and striped with red, and an opaque and often bloody liquid 

 is usually found in the calices and pelvis of the kidney, which like- 

 wise are injected with blood. Microscopic examination does nol 



