CHRONIC BRIGHT'S DISEASE. 29 



arise in parenchymatous nephritis the headache, the convulsions, the 

 coma, etc. simply to a poisoning of the blood ; and for many cases at 

 least I agree to the equally one-sided views of Traube, according to 

 whom the so-called uraemic symptoms depend upon oedema of the 

 brain and cerebral anaemia. Since the first appearance of my text- 

 book, I have been much gratified at the steady advance made by the 

 doctrine which I propounded long ago, that the symptoms of the so- 

 called cerebral pressure, due to encroachment upon the cavity of the 

 cranium, whether by a depression of the skull, haemorrhage, tumor, 

 abscess, inflammatory exudation, or serous transudation, all depend 

 upon an arrest or obstruction to the flow of blood to the ganglion-cells 

 and nerve-fibres of the brain. But, in spite of the experiments of Munk, 

 I hold it to be unproved, and even improbable, that the acute cedema of 

 the brain in Bright's disease should have an origin different from that 

 of cedema of other regions, or that it should be ascribable to an increase 

 of pressure within the cerebral arteries. Moreover, it seems to me to 

 be extravagant to encleavor to ascribe all cases of so-called uraemia to 

 compression of the cerebral capillaries, and to anaemia of the brain. 

 My position in this question is as follows : In chronic parenchymatous 

 nephritis, various organs are subject to O3dema, the precise cause of 

 which is unknown. It is characteristic of this cedema, that it shifts its 

 position. It may attack the lungs at any period, either early or late 

 in the disease, sometimes causing death, and sometimes subsiding 

 again after a short duration. In a manner precisely similar, and for 

 the same unknown reason, the brain may become the seat of an acute 

 or subacute cedema, to which many succumb, while in others the cedema 

 changes its position, and the patients are restored to a state of tolera- 

 ble comfort for a period of variable duration. Many cases of so-called 

 uraemic intoxication, but by no means all, are the result of cedema of 

 the brain, and consequent anaemia of the cerebral capillaries. We 

 may infer that an attack of this kind depends upon such an cedema, 

 and not upon blood-poisoning : 1. When the seizure takes the form 

 of deep coma, with intercurrent eclamptic spasms. 2. When, at the 

 time of its occurrence, the secretion of urine is normal or increased. 3. 

 When the attack is accompanied by marked cedema of the face. 4. 

 When the carotids pulsate strongly during the attack. As we shall 

 see directly, this is a valuable but often ill-appreciated sign of repletion 

 of the cranial space with blood, and of impediment to the exit of the 

 blood from the same. 



[The temperature in uraemia may be either increased or dimin- 

 ished. According to Bourneville, the average temperature is re- 

 duced, but rises during the fits, and remains high during the inter- 

 vals. In fatal cases it is very high, but it sinks gradually to the 



