32 DISEASES OF THE KIDNEY. 



patient to micturate, the daily secretion of urine is decreased, the 

 percentage of albumen augments, numerous casts and cellular forms 

 appear in the urine, and the dropsy makes further progress. Dur- 

 ing these long remissions of the malady the diagnosis may be difficult ; 

 or beyond a moderate albuminuria, which alone affords no proof of 

 Bright's disease, the patient presents but vague symptoms, such as 

 gastro-intestinal disturbance, anaemia, and loss of flesh. A patient 

 is thus not unfrequently supposed to be convalescent, or even cured, 

 until, sooner or later, relapses occur ; so that, after an average dura- 

 tion of about two years, he succumbs to dropsy, to secondary inflam- 

 mation of vital organs, or perhaps to uraemia. Should he escape 

 all these dangers for a considerable time (as may happen exception- 

 ally), then the active symptoms of the parenchymatous form of 

 Bright's disease may give place to that of shrinking and atrophy. 

 There will be a very profuse pale urine, of low specific gravity, 

 containing a moderate quantity of albumen (sometimes, though very 

 rarely, absent), and but few or no casts. 



PROGNOSIS. While recovery from acute diffuse nephritis is by 

 no means uncommon, the prognosis in the chronic form of the mal- 

 ady is far less favorable ; and indeed it becomes almost absolutely 

 bad as regards old or neglected cases, or when, from the condition 

 of the heart and of the urine, an irreparable atrophy of the kidney 

 can be made out. Nevertheless, even in some of these cases, though 

 incurable, a hope may be held out of a tolerably comfortable exist- 

 ence for some years, or at least so long as the dropsy is moderate 

 and transitory, as the serous cavities are free, and as the secondary 

 lesions and the uraemia do not appear, and while the patient main- 

 tains his digestive powers. When the disease is recent and has 

 been well and promptly treated, the prospects of complete cure are 

 a little better. Sometimes the malady seems to run a medium 

 course between that of the acute and chronic forms. The immedi- 

 ate danger is then much increased, but the hope that, after many 

 weeks or even months, a complete recovery may take place, is much 

 more warrantable than in the chronic form. In a diffuse nephritis 

 which is secondary to some other grave disorder, such as an old 

 malaria or a tedious suppuration, the nature of the primary affection 

 must be considered in the prognosis.] 



In respect to the duration and results of Bright's disease, it 

 may be said that there are cases which run their entire course in a 

 period of from six weeks to three months, and others in which the 

 malady drags on for years. I used to know a physician of large 

 practice in Altmark, who only died within a few years, although he 

 had all the symptoms of Bright's disease as long as twenty years 



