Renal disease is associated with in sanity in two ways: (1) acute transient delirious mania, an acute toxaemia. or tirinie insanity. and (2) a progressive cerebral degeneration. with chronic renal disease as the primary cause. in this type the mental symptoms during the earlier stages vary from a mild dementia to mania or delirium. In due course, however, complete dementia re sults not unlike paralysis of the pro gressive type known as general paralysis of the insane.
In some cases the spinal symptom- become marked, and changes in the spinal cord are found after death.
The dyspmeic and gust ro intestinal forms of nrcemin are sometime,. seen in the insane, but it is with the comatose and convulsive types that asylum phy sicians hare chiefly to do.
Out of 3000 eases admitted to Beth lem since the year ISAS, 172 had albumi nnria on admission (or 5.7 per cent.); of these 172, as ninny as 40 (or 23 per cent.) recovered from the mental at tack: of the remaining 132, 37 died of general paralysis and 20 of senile de mentia, and the remaining 75 became incurables. On careful analysis of the details of these 172 eases, is to be noted t he compara t ive frequency f such symptoms as inequalities of the pupils. tongue tremors, alterations and defects of speech, sluggishness or exaggeration of the knee-jerks, and not infrequently hemiplegias. or other symptoms of ar terial and cerebral degeneration. The eases diagnosed as general paralysis ap peared to have been of three types: parasyphilitic types, which correspond most closely to the classical descriptions of general paralysis; (2) types of cere bral degeneration clue mainly to vas cular changes consequent upon kidney disease; and (3) types of associated mental and motor defects in which the kidney disease is merely coincidental, the mental and motor symptoms being due to other factors, such as sunstroke. malaria. post-febrile and toxic states. T. B. Ilyslop (Practitioner. Nov.. 1901).
2. Acute nephritis may also be the result of other of the infectious fevers (small-pox, typhus, typhoid, relapsing fever, cholera, diphtheria, yellow fever. measles, chicken-pox. erysipelas, septico pyannia, acute lobar pneumonia, cerebro spinal meningitis, dysentery, acute ar ticular rheumatism, and tuberculosis; syphilis is rarely a cause).
Interesting ease of lnemorrhagic ne phritis consecutive to grippe, in a woman 32 years of age, the hannaturia lasting three weeks. Bock (Deutsche med.-Zeit.,
Apr. 2, '94).
Case in which mortal nephritis fol lowed mumps. Le Roy (La France Mod. et Paris Med., Nov. 23, '94).
Occurrence of nephritis in secondary syphilis in a case investigated in Birch Hirschfeld's laboratory. The patient died in coma. At autopsy the lungs, spleen, liver, lymphatic glands, and kid neys were all found to be the seat of more or less interstitial inflammation. The kidneys were large, and on section showed signs of subacute interstitial nephritis; the epithelium of the tubules, which were much compressed, was only slightly affected, These changes believed to have been due to syphilis. The ne phritis could not have been of mercurial origin, for it would have been parenchy matous, and not interstitial. Doederlein (Mlinchener med. Woch., Oct. 13, '96).
Acute interstitial nephritis found in 42 cases of infectious diseases, most fre quently in diphtheria and scarlet fever. The interstitial tissue in these cases is infiltrated diffusely and in foci by cells resembling the plasma-cells of Unna. No satisfactory explanation can be given for the almost constant tendency of the infiltrating cells to collect, especially in the boundary zone of the pyramids, the subcapsular region of the cortex, and around the glomeruli. W. T. Council man (Jour. of Exper. Med., July and Sept., '98).
It may also supervene as a primary condition, and the brunt of the attack may be sustained either by the kidney, rather than by any other part, or by the organism as a whole, as in the fevers.
Mannaberg has described such cases, and has demonstrated the presence of strep tococci in the urine.
Relation of acute nephritis and the streptococci found in endoearditis, espe cially those of experimentally induced bacterial endoearditis. In eleven cases of acute Bright's disease the urine found to invariably contain streptococci, which disappeared from the excretion with the disappearance of the symptoms of dis ease. In patients affected by other maladies, and in healthy individuals, this micro-organism was not found, al though searched for in a long series of samples of urine. Mannaberg (Zeit. f. klin. Med., B. 18, H. 3, 4).