ACUTE BRIGHT'S DISEASE. 13 



tendency to shift its position, the swelling increasing in one part of 

 the body, while it diminishes in another. 



When the progress of the disease is favorable, the coagula which 

 block up the uriniferous tubules are washed away, the urine be- 

 comes freer and more abundant, and the albumen diminishes. At 

 the same 'time there is an abatement of the dropsy, which, in this 

 disease, seems rather to depend upon suppression of the secretion of 

 urine than upon that lack of the albumen in the blood which takes 

 place in acute hydrsemia. In the most fortunate cases, the dis- 

 ease may terminate in from eight to fourteen days, recovery being 

 complete and without sequelae. In very many instances the nephri- 

 tis is accompanied by acute inflammation of the lung, pleura, peri- 

 cardium, or peritonaeum, and it is to one of these complications that 

 the patient usually succumbs in fatal cases. 



It happens much more rarely that croupous nephritis, instead of 

 terminating in the above manner, gives rise to the so-called uraemic 

 intoxication. It is easy to comprehend that, in consequence of the 

 suppression of the urinary secretion, substances may accumulate in 

 the blood which act perniciously upon the nutrition and functions 

 of the various organs. It used formerly to be supposed that the 

 urea, which is the most abundant of the solid constituents of the 

 urine, and which is the best known of all its organic ingredients, by 

 accumulating in the blood, induced convulsions, coma, and ultimate 

 palsy of the entire nervous system ; and when such symptoms ac- 

 companied suppression of urine, they were called uraemic symptoms, 

 or uraemic poisoning. Frerichs afterward supposed that this toxic 

 effect was due to the presence of carbonate of ammonia, resulting from 

 decomposition of the urea, rather than to the urea itself. This the- 

 ory, however, cannot by any means be regarded as proved, and we 

 must acknowledge that we are unacquainted with the excrementitious 

 material retained in the blood, which exerts so pernicious an in- 

 fluence upon the organism in cases of suppression of urine. How- 

 ever, notwithstanding the rarity of uraemic poisoning in croupous 

 nephritis, yet it is of great importance, as regards both the prog- 

 nosis and treatment of the disease, not rashly to ascribe any con- 

 vulsions or stupor which may arise to inflammation and exudation in 

 the brain. Cases occur in which the convulsions and coma subside 

 as the free secretion of urine is reestablished, and the attack termi- 

 nates favorably. (For further details of the so-called uraemia, and of 

 the frequent dependence of cerebral symptoms upon oedema of the 

 brain, see Chapter IV.) I should finally state that cases of croup- 

 ous nephritis occur in which the disease improves somewhat, but 

 does not subside completely ; the albuminuria continues, and the 



