Southern Medical and Surgical Journal - Georgia Regents University

|420 Brighfs Disease. [July,economy is depressed in its features,—he is forgetful, and listless.These symptoms diminish if the secretion of urine becomes^more abundant, and sometimes they disappear entirely fortime. In other cases they gradually increase in intensity; thelsleepiness passes into stupefaction ; the patients, who at firstcan be roused by speaking to them loudly, or by other meanSjjand will then give rational replies, now sink into everdeepenincrlethargy ; it is impossible any longer to arouse them ;jrespiration becomes stertorous, and is replaced only by the]gurgling of death. They generally lie perfectly still, withoutspeaking. Delirium is rare ; when it does occur, it is of the,low muttering description ; the patients repeat, times withoutnumber, a few words or sentences. Death is often precedecby convulsions ; trembling of the hands : distortion of the features,becoming quickly followed by clonic spasm, extendin|over the whole system of voluntary muscles. This is th(more common form of nervous disturbance in Bright's disease.It may last for a longer or shorter time, and is often capriciousin its course. Nevertheless, it is more to be dreaded than anyother complication, for it is the most certain herald of a fataltermination. Differing from it in its manner of appearance,and very essentially different in respect of prognosis, is the2. Acute form of UrcBmia, which commences suddenly, andin a short time reaches its full intensity. It appears to attackthe patient in one of three ways, the first symptoms being eitherthose of depressed cerebral function, of irritation of the spinalcord,orof a combination of thetwo. Frerichs confirms, from hisown experience, the statement of Dr. Addison, that when (underdepressed cerebral function) the respiration becomes stertorous,there is not the deep guttural tone heard in hsemorrhagicapoplexy, from the movements of the velum palati,but that thesound is of higher pitch, and is caused by the passage of airagainst the hard palate and the lips. He also adds his testimonyto that of Dr. Bright with regard to the persistence ofconsciousness in some cases where uraemia has evidenced itself (first by convulsion. Although the prognosis is more favorablejwhen the attack has this acute character, inasmuch as it genierally follows a sudden suppression of the urinary secretion, yetit may prove fatal in a few days, or even hours; and the result imust be anticipated as very unfavorable when acute uraemic iintoxication occurs, as it does not unfrequently. during the !course of chronic Bright's disease. A sudden change in thequantity or quality of the urine, disturbances of the organs ofsense, etc., are insisted on as of importance in the light ofwarning symptoms. There are cases, however, where theseare entirely wanting, and the diagnosis may be attended withj