Particular attention to the high arte rial tension in cases of chronic Bright's disease, and to the renal inadequacy and retained substances as an important factor in the etiology of the symptom. Musser (Times and Register, Oct. 17, '91).
It may be provoked by vasoconstric tion, and is, in such cases, a signal of uroemia.
Form of uremia which manifests itself in the mouth and pharynx: bucco pharyngeal urmmia. Marked by the presence in the mouth and pharynx of a thick, gummy mucus, covering the walls of these cavities. When it is de tached the membrane beneath is red and dry, but not ulcerated, although the similarity to a pseudomembranous for mation is close enough to mislead the incautious. It is not infrequently ac companied with hiccough, bulbar dysp nma, and other cerebrospinal phenomena, and presents a number of analogies to vomiting known to be of central origin. Lancereaux (Sem. Med. and Gaillard's Med. Jour., Mar., '91).
With these conditions may be asso ciated catarrhal bronchitis, with cough and expectoration.
There is frequently a moderate degree of cardiac hypertrophy of the left ven tricle; later there are dilatation and weakness of both ventricles. There is an accentuation of the aortic second sound and an increase of the pulse tension.
Origin of the cardiovascular changes in Bright's disease; the hypertrophy of the heart is a true hypertrophy with, in some cases, a mild interstitial myocar ditis, the left ventricle alone being en larged in a little over half of the cases, the remainder showing enlargement of both ventricles, the right never being en larged alone; the changes in the blood vessels are first an inflammation affect ing the intima, and then a secondary degeneration both of the intima and of the muscularis, which is not hy pertrophied, even when thickened. Two divisions may be made to include the cases of associated cardiovascular and renal disease, the first being arterio sclerotic in which some irritative sub stance in the blood, such as lead or the poison of gout, excites a primary endarteritis in the whole arterial sys tem including the kidney; the second division includes those cases in which the renal disease is primary, and, as the damaged kidneys are unable with the ordinary rate of the circulation to elimi nate all of the products of metabolism brought to them, those which remain be hind influence the heart through the nervous system to propel the blood faster, and hypertrophy results; when this hypertrophy affects the right ven tricle it is the result of the increased blood-supply to it; the blood-vessels be come affected later, both by the original cause of the renal disease and also by the toxic state of the blood due to de fective renal function. Tyson (Jacobi
Festschrift; Phila. Med. Jour., May 26, 1900).
Headache, vertigo, sleeplessness, nau sea and vomiting, diarrhoea, and stupor,. coma, or delirium may all develop and form the symptoms of a urfemic condi tion.
These symptoms, as a rule, precede a fatal termination. The convulsions that are common to chronic nephritis without exudation do not appear, however. In quite a large number of cases nuric neuroretinitis occurs, and is denced by dimness of vision and defects. In certain cases of marked cedematous distension the skin of the legs becomes subject to a red eczematous eruption. The temperature is practically normal in the absence of such ing inflammations as pericarditis, carditis; pneumonitis, and ulcerative colitis, all of which are rare conditions. Chronic exudative nephritis may either continue from bad to worse, and death may end all in a year or two, or albuminuria, and dropsy may appear in a person that has, for years previously, enjoyed apparently good health. After a first attack a second proves fatal within a few months. On the other hand, certain cases may show a slight pallor, a slightly diminished quantity of urine of high specific gravity, and containing albumin, and yet may complain of no inconvenience for years. Decided attacks may then occur at in tervals, during which the dropsy, dysp nooa, etc., may be absent, although a certain amount of albuminuria persists; these attacks last for several months. The average duration of the disease varies from one and one-half to three years.