CHRONIC BRIGHT'S DISEASE. 27 



Of these, inflammation of the lungs, of the pleura, pericardium, perito- 

 naeum, and meninges, deserve the first mention, as they are extremely 

 frequent complications of Bright's disease, and because it is of these 

 intercurrent affections that the patient most frequently dies, far more 

 frequently, indeed, than of the so-called uremic symptoms to be de- 

 scribed presently or even of excessive dropsy. Such inflammations 

 of the lungs, pleura, etc., do not differ from similar inflammations in 

 other conditions of anaemia. The patient seldom succumbs at once to 

 .the first attack; and we not uncommonly find vestiges of previous 

 ' inflammation, such as adhesions of the pleura, pericardium, and peri- 

 tonaeum, besides the marks of the final seizure. Parenchymatous 

 nephritis is often complicated by catarrh, particularly by catarrh of 

 the bronchi and intestine. There is nothing peculiar about the for- 

 mer, although in some cases the secretion is tolerably copious. The 

 latter, however, is almost always characterized by a very abundant 

 serous transudation, and by its extreme obstinacy. It would seem 

 that the eame. cause which induces the escape of such large quantities 

 of liquid into the subcutaneous connective tissue also gives rise to this 

 immense transudation upon the free surface of the bronchial and in- 

 te'stinal mucous membrane. Nevertheless, since the dropsy is not in- 

 variably accompanied by catarrh, it must be admitted that its origin 

 is somewhat obscure. 



According to my experience, chronic oedema of the lung is of very 

 common occurrence in Bright's disease. It gives rise to great dyspnoea, 

 to a tormenting cough, and, at the climax of the coughing-fit, not unfre- 

 quently induces vomiting. I have had repeated opportunity of observing, 

 whenever the vomiting caused the patient to eject much secretion, 

 that his breath became freer for a while, his cough ceased, and that 

 the fine subcrepitant rales subsided. Paroxysms of so-called urinous 

 asthma, which are said to occur in Bright's disease, are probably de- 

 pendent in a great degree upon oedema of the lung. 



Many patients with parenchymatous nephritis suffer from disease 

 of the heart. Besides the adhesions of the heart and pericardium 

 from former pericarditis, and the valvular derangement resulting from 

 endocarditis, none of which are uncommon in Bright's disease, we 

 very often find a hypertrophy of the heart, and more especially a 

 hypertrophy of its left ventricle. Traube has advanced the theory 

 that this hypertrophy is a result of derangement of the circulation 

 of the kidney, which he claims should augment the labor of the 

 heart. This theory is disputed by Bamberger and others, who reply 

 that the hypertrophy develops in a stage of the disease when no 

 obstruction of any importance to the circulation of the kidney ex- 

 ists. A more extensive collation of facts will be necessary to decide 



