The cedema is prominent and persist ent, gradually extending all over the body; thus pitting may be obtained on pressure on the limbs, chest, abdomen, and back.
The loose subcutaneous tissues, as of the penis, scrotum, and eyelids, are es pecially distended. Only in chronic hmmorrhagic nephritis may the cedema be absent or very slight. Chronic exu dative nephritis, especially with large white kidney, shows a pasty, pallid skin and anasarca as its most distinguishing characteristics. For several months the dropsy may be of moderate degree and almost stationary; it then grows worse insidiously, in spite of all efforts at treat ment, and death ensues in a month or two.
Case in a man, 50 years of age, in whom oedema had occurred in various positions: face, hands, feet, and scro tum. At one time he was rather sud denly seized with severe attack of dyspncea, due to an cedema of the pharyngeal walls and those of the upper part of the larynx. In the course of sev eral days, under the use of a spray of carbolic acid and an absolute milk diet, the oedema disappeared. Mendel (Ann. des Mal. de l'Oreille, etc., May, '91).
Form of (edema which is to be ex cluded in the consideration of the symp toms of Bright's disease. It is super ficial in persons free from any traces of albuminuria and unaffected by any alterations of heart or lungs. In none of the cases met has the author been able to establish any relation with the hwmic condition, as in chlorosis. The administration of iodide of potassium having led to rapid disappearance of the cedeina from four cases, the phenomenon ascribed to some syphilitic affection of the vasomotor system. Tschirkow (Meditzinskoje Obozrenije, No. 2, '91).
A large number of cases in which oedema of the glottis was the only symp tom of Bright's disease localized in the larynx. Occurs as an incident in the course of the disease or as the initial symptom of latent Bright's disease. Twelve such cases recorded. It may lead to death in several hours. Maire-Amero (Ann. des Mal. de l'Oreille, etc., Mar., 94).
Three eases of swelling of the eyelids associated with occasional albuminuria, two eases of occasional swelling of the eyelids but without albuminuria, and one case of occasional swelling of the eyelids in which albumin was always present in the urine, all in children. In none was there a history of scarlet fever. These may indicate the early stages of insidious nephritis with small white kid ney, but more likely only of vasomotor instability or defective metabolism. T.
Fisher (Brit. Med. Jour., Apr. 14, 1900).
There may be present in serious cases dropsy of the serous sacs, with its panying distressing symptoms; oedema of the larynx and lungs may then vene, causing sudden death. Dyspncea may occur, both toxic and nervous, as well as mechanical or cardiac, in origin. On lying down, cardiac dyspncea, due to failure of the heart's action and seen in many instances, is aggravated, as a rule. Dyspncea of uraemia is divided into three forms: simple, characterized by acceleration of respiration and diminu tion of the fullness of respiration; par oxysmal, or Cheyne-Stokes, in which a period of apnoea alternates with one of dyspnma of regularly varying fullness and the spasmodic, which closely simu lates spasmodic asthma. Lancereaux (Jour. of Xerv. and Mental Dis., May, '91).
In many instances there is too great a tendency to regard as cardiac a toxaemic dyspncea. In such cases of dyspinea, where no auscultatory symptoms are present, even if the urinary phenomena are not calculated to impress very strongly the fact of a decided renal alter ation, the possibility of urremie origin should be gravely considered. Several instances where the withdrawal of car diac stimulants and morphia, given with a view of correcting a cardiac error, and the substitution of remedies and meas ures for the correction of a toxaemia, were followed by a successful result. Landouzy (Jour. de Med. et de Chir. Pratiques, Aug. 10, '91).
[It has long been believed that the dyspncea of advanced Bright's disease is of toxEemie origin, and so it probably is in a number of instances; at least, in a certain degree. But, aside from the direct action of the toxic retention substances upon the respiratory centres or upon the respiratory tissues, there must be remembered the circulatory ele ment. ALLEN J. SMITil, Assoc. Ed., Annual, '92.] Attention called to the many similar features between the dyspucea of Bright's disease and that from accepted cardiac origin, — the breathlessness on even slight exertion, the distressing paroxysms at night, the influence of the horizontal position in increasing the severity, and the fact that Cheyne Stokes respiration is not infrequent in either. Steell (Med. Chron., Oct.. '91).