CHRONIC BRIGHT'S DISEASE. 21 



the Urinary bladder, and common both to chronic and to acute Bright's 

 disease, but which is never very severe, impresses the patient with the 

 idea that, in his frequent acts of micturition, he has discharged a large 

 quantity of water. Accurate measurement of the amount passed in 

 twenty-four hours shows that, in many cases, it does not quite reach 

 the normal flow. In others it is normal ; while in others, again, the 

 proper quantum is really exceeded. A considerable diminution of the 

 normal secretion or actual suppression of urine seldom occurs, and then 

 merely forms, as it were, a short episode in the disease. This peculiar 

 behavior of the urinary secretion, in chronic Bright's disease, is alto- 

 gether enigmatical. The slighter degree of suppression, which is the 

 most frequently observed, admits of the easiest explanation ; as the 

 obstruction of numerous tubules by swollen and degenerated epithe- 

 lium would obviously impede the outflow of the urine, and the com- 

 pression of many of the glomeruli must effect a diminution in the 

 amount of urine secreted. But how shall we explain the fact that, in 

 .many instances, in spite of this hinderance to the discharge, and in spite 

 of the limitation of the secreting surface, the flow of urine still remains 

 normal, or even is abnormally profuse ? How account for the fact 

 that the increase in this secretion is peculiarly common in the third 

 stage of the disease, at a period when the kidney is atrophied, and 

 when many of its tubules and Malpighian capsules have collapsed and 

 wasted away ? We admit that the hypertrophy of the left ventricle of 

 the heart may perhaps assist in augmenting the secretion of urine bv 

 increasing the pressure within the glomeruli, which still remain intact, 

 thus hastening the filtration of liquid through them ; but its influence 

 is by no means to be so highly rated as to suppose that the absence 

 of many defunct glomeruli can be more than compensated for by in- 

 crease of internal pressure upon those which remain. Nor does the 

 collateral fluxion to the remaining glomeruli, induced by obliteration of 

 the blood-vessels in the affected portion of the kidney, do more than 

 to explain why there is not a material decrease in the secretion of 

 urine, and by no means accounts for its augmentation. There is some 

 probability that privation of the blood of its albumen may have some 

 effect in increasing the secretion from the kidney. As is well known, 

 a liquid will pass more freely through an animal membrane from a 

 dilute solution of albumen, than from a solution which is more concen- 

 trated, the pressure being the same. But even this does not seem to 

 account for the increased production of urine which we so often observe 

 in the third stage of Bright's disease. 



Although, as before said, neither pain in the region of the kidney, 

 nor any unusual flow of urine, calls attention to the grave disease 

 which is going on, yet its recognition is no longer difficult, since it has 



