4. On two occasions a very extensive and profuse dermatitis seen, closely re sembling the universal exfoliative derma titis of Wilson, very red, very scaly, occupying the scalp, palms, soles, and genitals, as well as the trunk, face, and limbs. It has come on after the symp toms of Bright's disease have appeared, in cases of chronic interstitial nephritis, with little dropsy, and cardiovascular changes already apparent. P. H. Pye Smith (Brit. Med. Jour., Nov. 30, '95).
Debility and emaciation become ex treme, with the gradual faiure of the general nutrition.
Urfemia may supervene at any time, and may even form the first symptom; it may also be sudden and severe in its attack (acute uraemia), or gradual, mild, and insidious (chronic). These unemic attacks may be accompanied by either a normal temperature, or by moderate fever; the temperature may even be sub normal, in chronic ummia with prostra tion, coma, a feeble pulse, and delirium.
Among the complications that may occur in the red, granular, and con tracted kidney are the following: Plan ritis, endocarditis, pericarditis: pneu monia, either lobar or lobular: laryngitis, bronchitis, hepatic cirrhosis, gastritis, enteritis, peritonitis, meningitis, emphy sema, phthisis, and mental disorders.
Early in the establishment of chronic Bright's disease. especially the intersti tial variety, the mind seems somewhat fogged or "muddy," the soundness of business judgment is apt to be impaired; there are irritability, petulance, and de pression often noted; the patient may become a little self-distrustful, suspi cious, or somewhat secretive about his affairs or intentions; he is easily an noyed by loud noises, is disinclined to exercise his intellect, apt to doze in the day and be wakeful at night, and in many ways indicates the approach to the borders of insanity. Andrew Clark (Brit. Jour., Feb. 4, '83).
Case of a patient who suffered from insanity and chronic nephritis. When ever the renal disease was exacerbated, the patient's mental condition also be came worse.
Case of a lady, in whom the autopsy showed interstitial nephritis, who passed the last of her life in a state of acute delusional insanity. Raymond (Gaz. Med. de Paris, Nos. 25 and 26, '90).
Similar case, except that the patient became cataleptic and manifested bulbar phenomena, a short while before death. Brissaud and Lorring (Gaz. des Hop.,
Nos. 31 and 32, '90).
Important to distinguish those cases where the insanity exists along with, but independently of, the renal condi tion, not being influenced either in its inception or in its manifestations by the nephritis, and those cases which are called into being by the toxication from the renal inadequacy, or those which, existing perhaps latently as an heredi tary predisposition, are intensified by the influence of the disease of the kidneys so as to become manifest. The latter classes of eases may be examined as to their mental condition, with a view of estimating as well the degree of failure of the renal function; while they are more yielding, the treatment of the un derlying nephritis modifies the sympto matic mental condition. Joffroy (Le Bull. Med., Feb. 4, '91).
Case in which alternation of coma with maniacal outbursts and with occa sional delirium marked clearly the re lationship between the ordinary manifes tations of uremia and conditions of alienism. The patient eventually recov ered from all active symptoms. Remon dino (Jour, of Nerv. and Mental Dis., Oct., '91).
Number of cases and statistics show ing the frequency of nephritis in in sanity. Bondurant (Dour. of Nerv. and Mental Dis., Nov., '92).
Affections of the kidneys are very common among the insane. Urmmic poisoning is one of the most frequent causes of insanity. Alice Bennett (Alienist and Neurol., Oct., '94).
[We doubt very much whether Dr. Bennett finds many followers in her con fession of faith. We venture the pre diction that, of 1000 cases in ordinary life, as many cases of kidney disease will be found as in the same number of the insane, if general paretics are excluded. We have made it a subject of careful observation for some years, and have not found the proportion of kidney lesions which Dr. Bennett appears to have observed. In the few cases of "grave delirium" which have come under our care this point has been especially examined with negative results, and the same may be said in the majority of in stances of mental depression and anxiety. BRUSH, Assoc. Ed., Dept. of Mental Dis., Annual, '91.] Mental aberration—illusions, halluci nations, general confusion, impairment of memory, aphasia, neuralgia, paral ysis, etc.—connected with renal lesions. Bremer (Med. News, Oct. 20, '94).