Etiology. — Chronic nephritis with exudation may either follow acute diffuse nephritis (as of scarlet fever or preg nancy), or simple chronic congestion and chronic degeneration of the kidneys. It arises insidiously more frequently, however, and without any previous acute manifestation. Males are more subject to this form of chronic Bright's disease than females. Cases occurring in chil dren are usually preceded more or less recently by scarlatinal nephritis.
Heredity in chronic nephritis. Family history which showed in three genera tions in one family eighteen cases of chronic nephritis. Almost all the mem bers of the family in these three genera tions were subjects of nephritis. They had the disease for years, but reached an advanced age, and, almost without exception, became urinic and died in coma. The sex was equally divided. This series indicates a hereditary disposi tion of the kidneys to become diseased. Pel (Zeit. f. klin. Med., B. 33, B. I, 2, and 3, 1900).
Young adults are more commonly af fected with the usual form, developing subacutely. Beer-drinkers, and those who are accustomed to using malt and alcoholic intoxicants, seem especially liable to the disease. Even in cases where other manifestations are absent, it is not improbable that, in the in sidious cases, some toxic or infectious agency may act slowly and persistently, and be the cause of the nephritis.
The disease has been observed in cer tain individuals living in malarial re gions, and persons working under an exposure to cold and wet, or living in humid, marshy districts, seem more liable to the renal malady than those who are more carefully shielded from such influences.
A form of chronic albuminuria of less prognostic importance is that associated with chronic malaria. This is probably due to venous congestion during the at tacks of ague. Lauder Brunton (Brit. Med. Jour., Feb. 20, '93).
Three cases of nephritis following malarial fever, in which the symptoms, including albuminuria, disappeared on the administration of quinine. Stephan owicz (Wiener klin. Woch., No. 20, '93).
Cases of parenchymatous degeneration of kidney, proved by autopsy, in which the causative element was chronic ma larial infection. A. Gray (Jour. Ark. Sled. Soc., Dec., '94).
Case of nephritis in which ordinary treatment gave no result. A character istic access of ague pointing to etiology, large doses of quinine caused rapid im provement. Bermann (N. Y. Med. Rec., Dec. 23, '94).
Acute form less frequent among sol diers in Algeria and Tunis than in France, showing the influence of tem perature as cause; while the reverse is the case as regards the chronic form, pointing to effect of malaria in the eti ology of Bright's disease. Famechon
(Archives de M1d. et de Pharm. Mili taires, Jan., '95).
Conclusions to be drawn from a study of the relation of chronic nephritis to malarial disease: In some localities malarial fever should be given a promi nent position in the etiology of chronic as well as of acute nephritis. In all cases of malarial fever the urine should be closely watched. A blood-examina tion should be made in all cases of ne phritis occurring in those who have visited or lived in a malarial district, as it often happens that the severe grade of nephritis resulting may mask entirely the clinical picture of malarial fever. C.
W. Lamed (Johns Hopkins Hosp. Bull., July, '99).
This so-called "parenchymatous" form of chronic Bright's disease may find its cause in tuberculosis, syphilis, or chronic suppuration, and in such cases it is usu ally combined with amyloid disease (waxy degeneration).
Epithelial nephritis may follow in the course of syphilis, tuberculosis, and lep rosy, and which are quite distinct. It begins suddenly, as does subacute nephri tis, but its progress is slow. The urine is not abundant, is strongly albuminous, and the prognosis always grave on ac count of the danger of uremia. Lan cereaux (Le Bull. Med., Jan. 11, '93).
Syphilis may lead to a nephritis re bellious to treatment. Dieulafoy (Bull. de l'Acad. de Med. de Paris, June 20, '93).
Case developed suddenly without usual causes, during secondary period of syph ilitic infection. Thiroloix (Concours Mod., July 13, '93).
The nature of chronic nephritis: 1. The different forms of Bright's disease are to be regarded as various stages in the same general process, there being a unity pervading the whole pathological picture. 2. All forms of nephritis are due, in the immense majority of cases, to infective agents; the acute, to the usual specific germs of the primary dis ease, and the chronic, as a general rule, to the bacillus coli, though other germs may sometimes be concerned. 3. Acute interstitial inflammation and subsequent connective-tissue hyperplasia are the key note of the process; this is, however, preceded by parenchymatous degenera tion. 4. The point of invasion by the bacillus coli is the gastro-intestinal tract; those of other germs may be various. 5. The liver and mesenteric glands are the first barriers of defense; and the endothelial cells of the capillaries and the secreting tubules of the kidney have the power of ingesting bacteria, this being an attempt at inhibition and elimi nation. A. G. Nicholls (Montreal Med. Jour., Mar., '99).