16 DISEASES OF THE KIDNEY. 



afterward, is the natural and necessary consequence of the inflam- 

 matory process above described. 



Bright's disease is a very common affection. Predisposition to 

 it is far less in childhood than in more advanced life. Men are 

 attacked by it somewhat more frequently than women ; persons 

 of debilitated and depressed constitution more readily than those 

 who are robust. Hence the poorer part of the community are more 

 afflicted by the disease than the well-to-do class, being more ex- 

 posed to the evils which produce it. 



1. Chief among the predisposing causes of Bright's disease is 

 the temporary, and in a still greater degree the continual exposure 

 of the skin to the effect of cold and moisture. This accounts for 

 the great frequence of the disease in England, Holland, Sweden, 

 and on the German coasts ; and not only upon that of the North 

 Sea, as Frerichs has assumed, but also upon the eastern shore. In 

 the very moderate number of beds in the Greifswald clinic, there 

 used always to be many cases of Bright's disease. 



2. It would seem that the misuse of irritating diuretics and the 

 incautious exhibition of cubebs and copaiba may sometimes lead to 

 Bright's disease, although, perhaps, this does not pccur very fre- 

 quently. 



3. On the other hand, the abuse of ardent spirits unmistakably 

 plays a most important role in the etiology of the disorder, so that 

 Bright's disease appears almost as frequently among hard drinkers 

 as does cirrhosis of the liver. We have no physiological explanation 

 of this circumstance ; but as recent researches have proved that 

 alcohol taken into the system is not all consumed in the blood, as 

 used formerly to be supposed, but that at least a portion of it, pass- 

 ing through the urinary organs, is eliminated from the system unal- 

 tered, it is conceivable that the alcohol may act locally upon the 

 kidney, just as we have shown it to act in cirrhosis of the liver. 



4. Bright's disease very frequently is associated with tedious 

 suppuration, with caries and necrosis of the bones, the surgical 

 wards of the hospitals always furnishing a rich contingent of this 

 malady ; although the latter causative agents lead to amyloid 

 degeneration of the kidney with equal if not greater frequence. 

 The connection between these exhausting affections and Bright's 

 disease is obscure. However, just as in other cachectic conditions, 

 so the appearance of inflammation in the most diverse organs is so 

 common an occurrence in these depressing maladies, that it becomes 

 a question whether nephritis holds a closer relationship to such con- 

 ditions than is held by pleuritis, pericarditis, peritonitis, and the 

 like. 



