Persons ought to be warned, however, that this is a most serious disease, even in its appa rently mildest forms, and that, whenever pos sible, nothing should stand in the way of a sufferer from it being placed at once under responsible medical treatment.
Chronic Bright's Disease exists in a variety of forms: (I) as a chronic affection of the tubules, the consequence of the acute attack just described, (2) in the form of cirrhosis or thickening, producing what has been called the granular, contracted, or gouty kidney, and (3) the waxy or lardaceous kidney.
The first form is frequently the result of tak ing cold. In it the tubules are permanently affected, their epithelial cells being removed, and the tubes blocked with broken-down mate rial, wasting of the kidney following in time.
Its symptoms are chiefly alterations in the character of the urine, and dropsy. The urine is scanty, contains albumin; and the use of the microscope discovers in it numerous cells from the tubules, and casts of the tubules. The patient has a doughy, puffy look, the dropsy filling up the furrows of the face, and giving a smooth, glossy appearance. Outbursts of the acute attack are liable to arise, and inflamma tory attacks of other organs and affections of the heart and arterial vessels are not infre quent.
The second form is most frequently caused by abuse of spirituous liquors, specially whisky or brandy. It is also associated with gout and with lead poisoning.
In this form the connective tissue between tubules and blood-vessels is the chief seat of the alterations of structure. It is increased in amount and by its pressure on the blood-vessels diminishes their supply of blood while it causes wasting of the tubules. The whole organ be comes greatly reduced in size by the shrinking of the connective tissue.
Symptoms of the disease may not be evident for a long time, unless they are symptoms of di gestive trouble, common in all forms of Bright's disease. Sometimes the patient seeks medical advice owing to failure of sight, when a care ful examination of the eye reveals changes in the retina, the nervous coat at the back of the eyeball, associated with a diseased kidney, whose existence was not before suspected. Dropsy may be absent or very slight. The urine is pale, increased sometimes in quantity, but does not always contain albumin, though usually in small amount. Associated with this form of Bright's disease in particular are alter ations in the heart and arteries; affections of the lungs are common, bronchitis, pleurisy, &c., and uraemia, described in a previous paragraph, is the common cause of death. Recovery does not take place, but the person may live for many years, as the progress of the disease is very slow.
The third form of chronic Bright's disease, that of waxy kidney, is said to be the conse quence of prolonged exhausting disease, such as prolonged suppuration, disease of bone, con sumption, and syphilis. The kidney becomes altered in structure, the waxy change begin ning, it is said, in the blood-vessels and spread ing to the tubules, which become blocked up by a semi-transparent waxy material. As a result the kidney wastes and contracts.
Its symptoms are ill-defined, like those of the preceding form. The urine is very copious, pale and watery, the patient having to rise several times in the night to void it. It con tains little albumin at first, but the quantity increases. There is no dropsy. The patient gradually loses strength, but death may not result for several years, even five or ten, and is more commonly due to complications than to the disease itself.
Treatment of chronic Bright's disease.--It is impossible to give detailed instructions as to the treatment of chronic forms of this disease. Its complications, affecting stomach and bowels, lungs, heart and blood-vessels, brain and other important organs are so numerous that the treatment appropriate for each case can only be decided by a physician who knows his work and who takes all the circumstances of the case into his consideration. Sometimes a careful
scrutiny will reveal causes of the disease whose removal will tend to considerable improvement in the patient's condition, if not to recovery. Thus gout, syphilis, &c., should be treated if present. A general line of treatment can, how ever, be indicated, that is suited to all forms of the disease. The patient should avoid all ex posure to cold and wet. He may be able to select a warm, equable climate, or a sheltered place of residence where he is not liable to sudden great changes of temperature. He should always wear flannels. He should take moderate exercise, and should attend to the condition of the skin, so that by strict cleanli ness, and the frequent use of warm baths (taken, of course, with due precaution against cold), the free action of the skin is aided, and undue labour is thus prevented from being thrown on the kidneys. The bowels should never be allowed to become costive. In short, the patient must be surrounded by the healthiest possible conditions of life. The next object of treatment is the maintenance and, as far as possible, the increase of bodily strength. To this end the most nourishing food ought to be made use of, but of the most easily digestible kind. Milk in quantities may be allowed, and nourishing broths and soups, but the quantity of butcher-meat should be restricted. All albuminous food-stuffs (p. 191) throw work on the kidneys, since the result of their breaking down in the body is the produc tion of urea, whose expulsion it is the business of the kidneys to provide for. Limitation of this kind of food, therefore, diminishes the quantity of urea and lessens the work of the kidneys. Chief among the means of streng thening the body is the administration of iron tonics, in the form of quinine and iron wine, or with strychnine as Easton's syrup (of which to 1 tea-spoonful is a dose for an adult), and other similar preparations. The use of ardent spirits should in all cases be avoided. This is a general line of treatment, as already said. The treatment of dropsy, which is sometimes relieved by puncturing the dropsical parts, sometimes by free purgatives and, by other means, is entirely dependent on the circum stances of the patient, of which only a medical man can form a proper estimate. It is some times very greatly and rapidly reduced by a diet as free of common salt as possible. Food should be cooked and eaten without salt.
Suppuration of the Kidney is an inflam matory disease of the kidney accompanied by the formation of matter. The substance of the kidney is the seat of the disease, in which ab scesses may form. It may be caused by inflam mation passing upwards from the ureter or bladder, or by the irritation of stone in the kidney, or by a poisoned condition of the blood —pysemia (p. 315), by injuries, or exposure to cold.
Among its symptoms are shivering fits (rigors), pain or uneasiness in the loins, albu min, blood, tube casts and matter in the urine.
Treatment.—This is a disease which will probably demand surgical treatment.
Inflammation of the Pelvis of the kidney (p. 392), called by physicians Pyelitis, is another form of inflammation which can only be men tioned in such a work as this. It is caused by exposure to cold, stone in the kidney, by ob struction to the outflow of urine causing it to be retained and to become decomposed in the cavity, or by blood-poisoning, and it is marked by attacks of fever, pain in the loins, and changes in the character of the urine, which contains matter in chronic cases. If the ob struction persist owing to the retained mate rials, the kidney becomes converted into a tumour with fluid contents—decomposing urine and matter. Such cases as suppuration of the kidney and pyelitia are now, as the result of aseptic methods, successfully dealt with by the aseptic surgeon.