A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Science
A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Medicine -- Practice
The Blood.--Both in acute and chronic Bright's disease the patients
often become markedly anæmic and pale. This change in the color of the
patient corresponds to an alteration of the composition of the blood
with the details of which we are not as yet fully acquainted. The blood
seems to be thinner and more watery.
Cerebral Symptoms.--Headache, drowsiness, stupor, sleeplessness,
delirium, coma, muscular twitchings, and general convulsions are of
frequent occurrence. The headache and drowsiness may continue during
the course of the disease for many months. The stupor, sleeplessness,
delirium, coma, muscular twitchings, and general convulsions are apt to
occur in attacks which last for several days, and then pass away or
terminate in the death of the patient. With such cerebral symptoms are
often associated dyspnoea, vomiting, increased temperature, and
diminution in the excretion of urine. The entire group of symptoms is
commonly known by the name of uræmia.
It is a matter of great practical importance to determine the cause of
these cerebral symptoms, for otherwise there can be no rational
treatment of them. It is evident that such cerebral symptoms must
depend upon anatomical changes in the brain or its membranes, or upon a
change in the composition of the blood which circulates through the
brain, or upon the quantity of blood supplied to the brain.
It is to be remembered that such cerebral symptoms occur most
frequently with the atrophic form of chronic diffuse nephritis; that
they are often the first symptom of renal disease; that the same person
may have several such attacks, with no cerebral symptoms during the
interval; that the urine is usually, but not always, diminished during
the attack, and becomes more abundant when the attack ceases; that such
attacks also occur with the chronic congestion of the kidney due to
cardiac disease, in pregnant women without kidney disease, and with
diseased arteries and high arterial tension without kidney disease.
Anatomical changes in the brain or its membranes do exist in a
considerable number of cases of chronic Bright's disease. Chronic
meningitis with thickening of the pia mater and an increase of serum is
quite common; anæmia and oedema of the brain-tissue are often seen. But
there are a great many cases with cerebral symptoms without such
lesions, and with such lesions without cerebral symptoms.
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