The dead finger is a vascular trouble in cardiac disease, or an hysterical phe nomenon, and has nothing to do with Bright's disease. The principal sign of renal insufficiency is the toxicity of the urine. The excretion of nitrogen in con siderable quantity by the faeces is also a good sign. G. See (Bull. de ['Acad. de Med. de Paris, June 27, '93).
Of the symptoms referable to the special senses nephritic retinitis often forms the earliest evidence of chronic Bright's disease. There may or may not have been present a slight dimness of vision prior to the ophthalmoscopical examination. There is a partial loss of vision in both eyes (amblyopia), and in grave cases sudden and complete blind ness may come on (urvemic amaurosis) as the result of a neuroretinitis. The optic papilla is swelled, and surrounded by retinal haemorrhages or by white dots and streaks ("feather-splashes").
The varieties of albuminurie retinitis are (1) neuritis (optic papillitis, or in terstitial neuritis with swelling and round-cell infiltration of the connective tissue of the nerve, leading, in some eases, to atrophy of the nerve-fibres).
(2) Neuroretinitis, in which the retinal expansions of the optic nerve become swelled and ultimately granular and fatty. With these changes are associated white patches, of which there are two kinds: (a) rounded, soft-edged areas of lymph-exudation and (b) smaller, bright, radiated streaks or specks. The latter are mostly seen radiating from the yel low spot. Their glistening appearance is due to the refractive power of the minute oil-globules of which they consist.
(3) Periarteritis; chiefly affecting the outer coats of the arteries, and causing them to become thickened, and to en croach on the lumen so as to obliterate the smaller ones. This condition is asso ciated with haemorrhages and capillary dilatations.
(4) Diffused opacity of the retina from oedema.
Diagnosis: None of the ophthalmic ap pearances described are patbog,nomonie of Bright's disease. Similar forms of neuritis and neuroretinitis are met with in cases of cerebral tumor, while luemor rhages may occur in cases of leucocytine mia, chlorotie and pernicious anwinia, and purpura. Multiple retinal periar
i teritis, though generally associated with nephritis, is met with apart from this condition. The oplithalmoseopical ap pearance must always be confirmed by some of the more obvious signs of Bright's disease.
Causation: Four causes: (1) dys crasia, or altered condition of the blood; (2) secondary degenerative changes in the small blood-vessels; (3) excessive pressure of blood within the vessels; (4) an inflammatory process of the affection of both vessels and nerves. Many re gard the changes as purely degenerative.
Prognosis: The grave class of cases includes diffuse neuroretinitis, radiating patches around the yellow spot, and mul tiple periarteritis. These are most com mon in contracting granular kidney. When the changes are marked he would place the extreme duration of life at two years. whatever the state of the general health might be.
An exception to this rule is in the case of puerperal nephritis. Here the condi tion mainly depends on pre-existing dys erasia of the blood, of which the retinal changes are only another local expres sion. Recovery is general, if pregnancy does not recur. The dyscrasia is not de pendent solely upon renal disease.
The benign class of cases includes simple edema, hcemorrhages, and soft edged patches. All these conditions may subside, and their presence does not make the prognosis of the case better or worse.
One may conclude, therefore, that the prognosis is based upon the nature of the oplithalmoseopical changes discov ered, and upon the nature of the ne phritis which caused them.
In interstitial nephritis, retinitis is a measure of the general amount of vas cular degeneration present. Advanced retinitis characteristic of interstitial nephritis, together with other signs of that disease, mean a speedy death.
On the other hand, signs of retinitis equally characteristic of other forms of nephritis are due to toxcemia rather than to vascular degeneration, and as such may be cured. Saundby ("Lectures on Renal and Urinary Diseases," '96: from review in Treatment, .Tune 24, '97).
Tinnitus aurium, deafness, and vertigo are not uncommonly present.