Notes on a case of inflammatory Bright's disease, fatal in the third stage / by T. Grainger Stewart.

Date:
1871
Catalogue details

Licence: Public Domain Mark

Credit: Notes on a case of inflammatory Bright's disease, fatal in the third stage / by T. Grainger Stewart. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    INFLAMMATORY BEIGHT'S DISEASE. It is essential to a proper understanding of the different forms of Bright's disease, to recognise the fact that atrophy results in all the varieties if the patient live long enough. From this it follows that diminution of size of the organ, with an uneven granular con- dition of the surface, is not characteristic of any single form ; and that for an accurate appreciation of any individual example of atrophic kidney, it is essential that we recognise the process in which it originated. I do not propose to refer at present to the advanced or atrophic stage of the waxy form, which is, I believe, very generally recog- nised. But as great confusion has arisen from confounding the advanced inflammatory with the cirrhotic disease, I propose to describe a case which appears fitted to throw light upon the dis- tinctions between these maladies. Let me, however, first remark that this confusion has resulted in two kinds of error: on the one hand, some authors credit the atrophic forms which are truly cirrhotic to the inflammatory process; while others refer the atro- phic inflammatory to the cirrhotic category. Now, if on post- mortem examination these forms which are really distinct are confounded, much inaccuracy in regard to the clinical history is of necessity introduced; each form getting, in the hands of dif- ferent authors, a history attached to it, more or less unreliable, being partially derived from that of other forms. It may render the divergence of opinion more distinct if I cite, in a few words, the views expressed by some of the leading authorities. Frerichs1 ascribes the atrophic forms to inflammation of the tubules, and gives no separate description of cirrhosis. Rosenstein,2 following the lead of Frerichs, blends the patholo- gical description and clinical history of the two forms, also taking no notice of the contracting kidney. 1 Die Brightische Nierenkrankheit und deren Behandlung, s. 35. Die Pathologie und Tlieiapie dcr Nieren Knmkhoiten, 2te aufl., s. 50 und