CHRONIC BRIGHT'S DISEASE. 17 



5. Finally, Bright's disease often accompanies conditions of dys- 

 crasia, resulting from gout, rachitis, syphilis, scrofula, and malarial 

 cachexia, in which, however, besides the inflammatory degeneration, 

 the lardaceous metamorphosis hereafter to be described is often 

 observable. 



I agree with Traube, that it is improbable that simple obstructive 

 hypersemia from disease of the heart and the like gives rise to in- 

 flammation of the kidney ; and I believe that, hitherto, there has 

 been a great deal of confusion of this malady with that described 

 in the preceding chapter. Nor can I regard pregnancy as one of 

 the remote causes of Bright's disease. The albuminuria so com- 

 mon among pregnant women is not generally a result of inflamma- 

 tion, but is rather due to a parenchymatous degeneration of the 

 kidney, to be described in Chapter VIII. 



[Malarious poison predisposes to Bright's disease, and, according 

 to Jfartels, is one of the most prominent of its causes. But an 

 albuminupia arising during an acute febrile disorder has never been 

 observed to terminate in chronic renal disease. On the other hand, 

 chronic suppuration with continued fever may be followed not only 

 by amyloid degeneration, but also by chronic inflammatory swell- 

 ing of the kidney. 



Those observers who regard parenchymatous and interstitial ne- 

 phritis as distinct diseases naturally ascribe each of them to differ- 

 ent causes. The causes of that form which develops so insidiously 

 and so very gradually in the interstitial substance are extremely 

 obscure ; and Cartels remarks regarding these so-called " contracted 

 kidneys" which he looks upon as a separate disease, that in scarcely 

 one of his cases could his patients even guess at any cause for their 

 malady over and above the influences which always more or less be- 

 set them. English writers ascribe shrunken kidney largely to gout 

 and to lead-poisoning. Dickinson states that twenty-six out of 

 forty-two persons with lead-poison had died of shrunken kidney. 

 While this form of renal disease is more common in advanced age, 

 the other oc'curs more often between the ages of twenty and forty. 

 In childhood it is rare, if we except cases of acute diffuse nephritis 

 following scarlatina. 



PATHOLOGICAL ANATOMY. According to the present views of 

 many, the term chronic Bright's disease must be regarded as em- 

 bracing two distinct forms of nephritis, the interstitial and the pa- 

 renchymatous. The former, according to Klebs, begins with intense 

 hyperaemia, with exudation of a lymph-like liquid throughout the 

 whole cortical substance of both kidneys, which dilates the lymph- 

 spaces of the interstitial tissue, and is accompanied by a constantly 



