KUGHT'g DISEASE. 151 



Blight's disease may arise from many different causes, one of the most common 

 being the somewhat complex process which is known as "catching cold." It is, of 

 course, not every one who catches cold who has an attack of Bright's, but still 011 

 inquiry it will be found that the majority of people who are suffering or have 

 siitfnxxl from this disease refer its origin to some exposure to wet or cold. Cold 

 operating slowly and continuously is also a prolific source of Bright's disease. 

 Persons whose occupations expose them to the inclemency of the season without 

 adequate protection, those who work in hot workshops and are in the hnbit of 

 i^oing out to cool their heated bodies in the open air, the indigent classes who, 

 insutlu-k'utly clad and ill-fed, dwell in damp cellars amidst dirt and squalor, 

 furnish a large proportion of victims to this disease. The abuse of spirituous 

 liquors also ranks high as a determining cause of Bright's. It is not the habitual 

 drunkard only who exhibits this tendency to kidney disease, but the dram -<1 rink t-r 

 who is in the constant habit of using ardent spirits several times a day without 

 becoming actually intoxicated. Malt liquors, though far less pernicious than spirite, 

 are, when largely indulged in, not without their influence in producing Bright's 

 disease. In the case of a journeyman baker, the complaint was clearly traced to the 

 patient's habit of fuddling himself with beer from Saturday night to Monday 

 morning, a practice which he had previously followed for many years. Very 

 frequently intemperate habits go hand-in-hand with exposed occupations, and it 

 hardly excites our surprise to find that a large proportion of cases occurs among 

 labourers, cabmen, carters, hawkers, glass-blowers, smelters, and puddlers. In 

 many instances the disease is undoubtedly owing to some constitutional taint, such 

 as scrofula ; and among the more opulent classes gout is a prominent antecedent. 



Bright's disease may occur either in an acute or in a chronic form. Acute 

 Bright's disease may arise from any of the causes to which we have already referred, 

 but in a large number of cases it follows an attack of scarlet fever. The functions 

 of the skin are interfered with by the rash and the subsequent desquaniation, or 

 peeling, and an excessive pressure of work is consequently thrown on the kidneys. 

 It is now well understood that kidney disease is not a necessary sequel of scarlet 

 fever, and that the scarlatinal poison is, under favourable circumstances, eliminated 

 entirely by the skin, so that it is only when the natural course of the disease is 

 interfered with by some disturbing cause, such as exposure to cold, that it is diverted 

 into other channels. The reason why dropsy so commonly follows a mild attack of 

 scarlet fever is that little importance is attached to the disease, and no care is taken 

 to protect the patient from the injurious effects of cold. 



There can be little difficulty in recognising the onset of an attack of acute 

 Bright's disease. A boy, we will suppose, has just recovered froni scarlatina, and 

 his friends, thinking that an airing will hasten convalescence, take him down the 

 river on the steamboat for a good blow. Towards evening he is very tired, says 

 he feels chilly, and is perhaps sick. The next morning he is worse, and complains 

 of a dull aching pain in the back and limbs. His countenance is pale and puffy, 

 and wears a heavy stupid expression, and there is distinct swelling of the limbs 

 and trunk. The thermometer shows that there is fever, the pulse is hard and full, 

 there is no appetite, thirst is excessive, and the skin is hot and dry. The urine is 



