CHRONIC BRIGHT'S DISEASE.
Contracting granular kidney may exist for a considerable time and may even be "in a serious degree of development" before the patient is aware that there is anything amiss with him. For years the appetite and digestion may remain unimpaired, and health and strength may seem perfect. Suddenly the appetite fails, the patient becomes dyspeptic, he is tortured with thirst, and passes a great deal of urine, so that he fears that he is afflicted with diabetes. The urine is often secreted more abundantly at night. Thus, Professor Carl Bartels relates an extreme instance of nocturnal poly uria, in which 101- pints (6,000 c.c.) were passed between 8 P.M. and 8 A.M. The urine had a specific gravity of 1.004, and contained albumin. Bartels says (Ziemssen's " Cyclopedia," Vol. XV., p. 431) : "No other patient of mine ever passed so huge an amount. In only one private case could I feel sure I had really estimated the entire quantity of urine passed for a whole month. This patient excreted on an average 111 ounces (3,350 c.c.) daily. The fact is remarkable that the patients are invariably more tormented with the desire to pass water by night than by day. One of my private patients, for
example, who throughout his day's work from 9 A.M. to 4 P.M. had no call to empty his bladder, was forced to get up three or four times every night to urinate. It appears that this greater frequency of the desire to micturate at night is founded upon the more abundant secretion which takes place at this time. The diurnal amount of urine passed by the above-mentioned patient was collected for a month, and upon twenty-six days out of this month the night urine was separated from that of the day. The day's urine, collected from 7 A.M. to 10 P.M., stood on an average at 1,370 c.c. (45 oz.), i.e., 3 oz. per hour; while the night's urine, consisting of that passed during the nine night hours, presented an average of 2,190 c.c. (72 oz.), i.e., 8 oz. per hour. This patient was forced to get up at least four times each night to micturate. Another patient passed in ten successive nights upon an average 960 c.c., i.e., 32 oz., each night, and upon the corresponding days only 65 c.c., i.e., 21 oz."