■ 
 
 
 1 
 
 I 
 
 Its Curability 
 
LIBRARY OF CONGRESS, 
 
 UNITED STATES OF AMERICA. 
 
*y 
 
 \K 
 
MAP of the VISCERA. 
 
 i. Gall Bladder. 3- Liver Duct. 
 
 2. Gall Duct. 4- Common Duct. 
 
 5. Pancreatic Duct. 
 
WHAT IS 
 
 Brights Disease? 
 
 Its Curability. 
 
WHAT IS 
 
 Brights Disease? 
 
 Its Curability. 
 
 By SETH PANCOAST, M. D., 
 
 Specialist in the Treatment of Chronic Diseases ; Author of Ladies' 
 
 Medical Guide, Treatise on Consumption, 
 
 The Kabbala, etc., etc. 
 
 v 
 
 WITH ILLUSTRATIONS. 
 
 
 ^OFWASHl^ 
 
 Philadelphia : 
 
 PUBLISHED BY THE AUTHOR. 
 1882. 
 
1/ 
 
 \ 
 
 
 K 
 
 
 Copyrighted, 1882, by 
 SETH PANCOAST, M. D. 
 
TO 
 
 THE SUFFERERS 
 FROM 
 
 BRIGHT'S DISEASE, 
 
 WITH 
 
 A HOPE THAT THEY MAY FIND INSTRUCTION 
 
 AND 
 
 CONSOLATION IN ITS PERUSAL. 
 
PREFACE. 
 
 It is customary in the preface for the author 
 to assign reasons, and offer an apology, for 
 writing the work. We have reasons for writ- 
 ing which we will state, but no apology to 
 offer. 
 
 The disease of which we treat in this work 
 is regarded hy many physicians as incurable, 
 even in its acute, but especially in its chronic 
 form. In our opiuion, the failure to treat, it 
 successfully is due largely to a wrong concep- 
 tion of its nature and cause, and this book 
 is written for the purpose of expressing the 
 author's ideas, and affording hope to those 
 suffering from this terrible malady. We claim 
 that the primary cause lies in the organic ner- 
 vous system which controls the nutrition and 
 growth of the entire organism, as well as the 
 elimination of the products of disintegration. 
 
 In the secreting structure of the kidneys 
 the disease is supposed to be first mani- 
 fested. This is a mistake, for it may exist for 
 many months, if not years, before albumen is 
 detected in the urine. The kidneys are not the 
 
 9 
 
10 PREFACE. 
 
 only organ involved when the disease be- 
 comes fully developed; we find the heart, 
 lungs, and liver participating, and this cannot 
 be from sympathy with the kidneys, but is due 
 to an ennervation of the nervo-vital energy, 
 the master-workman in controlling the func- 
 tions of the physical organism. The condi- 
 tions under which Bright* s Disease makes its 
 appearance, may be lurking in the organic ner- 
 vous system for years, before the patient, his 
 friends, or even his physician is cognizant of 
 it, and all at once, some exciting cause, such 
 as mental strain, cold, debauch, etc., reducing 
 the vital energy, brings it to the surface. So 
 long as it is treated as a local disease, exclu- 
 sively, successful results cannot be expected. 
 
 We have fully demonstrated its curability 
 within the last few years, to our own satisfac- 
 tion, as well as to that of many we have 
 treated. The ennervation of the vital energy 
 centered in the organic nervous system must 
 be corrected or replaced by normal action be- 
 fore local treatment applied to the kidneys 
 can assist in reducing the inflammation, thus 
 enabling the vital energy to overcome structu- 
 ral changes that have occurred, and to restore 
 the organ to its normal action. Great care 
 must be observed by the patient for fear of a 
 relapse, which is liable to occur until normal 
 
PREFACE. 11 
 
 vital action is firmly re-established. Our motive 
 in writing this work is evident : it is to set 
 forth our views on Bright' s Disease, and to 
 assure those who are suffering from it of its 
 curability, if there be not already too great an 
 ennervation of the vital energy and disintegra- 
 tion of the kidneys. 
 
 In conclusion, we would remark that repe- 
 tition of words and phrases, and even of state- 
 ments, is unavoidable in a work of this char- 
 acter, written expressly for non-professional 
 readers. 
 
 Seth Pancoast. M. D. 
 
 917 Arch Street, 
 
 March 1st, 1882. 
 
CONTENTS. 
 
 CHAPTER I. PAGB 
 
 The Structure of the Kidneys, 15 
 
 CHAPTER II. 
 
 The Nervous System, $3 
 
 CHAPTER III. 
 
 Function or Office of the Kidneys, 55 
 
 CHAPTER IV. 
 
 Abnormal Condition of the Kidneys in 
 
 Bright's Disease, $3 
 
 CHAPTER V. 
 
 What is Bright's Disease? It's Curability, . 97 
 
 CHAPTER VI. 
 
 Symptoms of Bright's Disease, 116 
 
 CHAPTER VII. 
 
 Causes of Bright's Disease, 
 
 CHAPTER VIII. 
 
 Advice to those Suffering from Bright's 
 Disease, 
 
 13 
 
DEFINITIONS. 
 
 Correlation and its Cognates. — " Correlation'/' is 
 derived from the Latin con-elatio, a triple-compound word, 
 from latus the participle passive preterite oifero, with the 
 successive prefixes re-, and con- ; etymologically, it denotes 
 " a bearing back upon" a person or thing; thus, the ordi- 
 nary dictionary definition is "a reciprocal relation," etc.; 
 but we employ this substantive, " correlation," and its 
 cognate adjective and verb, in a specific or technical ap- 
 plication, to denote the peculiar relation that obtains 
 between the Subjective, Primary Force, on the one hand, 
 and the Objective, Secondary Force, on the other hand. 
 The former is the direct instrument of the Spirit, and is 
 the Vital, the Life Force ; the latter is the same manifested 
 in material organization, as Nerve Force — the one centres 
 in the Soul, the other in the Nervous System of the Living 
 Organism. As the Soul and body of every living entity 
 are developed simultaneously, the Primary and Secondary 
 Forces must correlate in action and operation. 
 
 Nervo-Vital. — The foregoing definition suggests the 
 signification of this term ; the Spiritual Vital Force of the 
 Soul, to develop and sustain the physical bodv, must es- 
 tablish itself with the Secondary Nerve Force, and the 
 two correlate as the Nervo-Vital Force. 
 
 14 
 
CHAPTER I. 
 Structure of the Kidneys. 
 
 [See Frontispiece.] 
 
 The form of the kidneys somewhat re- 
 sembles the ordinary bean, the inner margin 
 being concave and extending inward towards 
 the spine; the outer edge is thick and 
 rounded and directed outwards. They are 
 situated deep in the lumbar region, on each 
 side of the spine ; the right is slightly lower 
 than the left, being depressed by the liver 
 which lies immediately above it. The kid- 
 neys are occasionally out of their natural 
 position — either in front of the spine or 
 much lower down in the abdominal cavity 
 — even as far as the cavity of the pelvis. 
 They are embedded in adipose or fatty tis- 
 sue, which is very profuse in fat persons, 
 while in thin, spare individuals, there is 
 scarcely a trace of it. The average length 
 of these organs is four to four and a half 
 inches, breadth two inches, and thick- 
 ness one inch ; the weight in males is five 
 to six ounces, in females, four to five ounces. 
 
 15 
 
16 BRIGHT'S DISEASE. 
 
 They are partially covered by the perito- 
 neum, which lines the abdominal cavity. 
 The right kidney is covered by the ascend- 
 ing colon or the ascending part of the large 
 intestine, and the left by the descending 
 colon, or descending part of the large intes- 
 tine. The right kidney is also in contact 
 with the duodenum and covered by the 
 right lobe of the liver, and occasionally a 
 part of its anterior surface is covered by the 
 gall-bladder. The left kidney lies in con- 
 tact with the spleen and is covered by the 
 large end of the stomach, when it is dis- 
 tended during the process of digestion. It 
 is important to understand the relation of 
 the kidneys with the colon or large intes- 
 tines. Abscess of the kidneys has been 
 known to burst into, the colon, and the 
 ulceration of the intestines would cause se- 
 rious structural change in the kidneys. 
 
 On the concave and spinal margin of the 
 kidney is a small depression or fissure, 
 called the hilum, through which the arteries 
 and nerves pass into the kidney and the 
 veins pass out. It is this depression where 
 the pelvis of the kidney begins. The ureter 
 or excretory duct extends from the hilum 
 
THE BLOOD-VESSELS. 17 
 
 to the base of the bladder. It is a small 
 canal composed of elastic tissue, varying 
 in size from a chicken to a goose quill. 
 At its commencement in the kidney and its 
 terminus in the bladder, it is dilated but be- 
 comes narrowed near the middle. It is in 
 the contracted portion of the ureter that 
 urinary calculi or gravel become lodged, in 
 their passage from the kidneys to the blad- 
 der, causing excruciating pain. This tube 
 is lined by a delicate mucous membrane 
 similar to that which lines the bladder and 
 kidneys. 
 
 The Blood- Vessels of the Kidneys : — 
 These consist of the renal artery and vein ; 
 the former is a branch of the abdominal 
 aorta and, previous to its passage into the 
 kidney, it gives off branches to the capsule, 
 ureter and surrounding cellular tissue. After 
 it enters the kidney, it divides into four or 
 five branches and again subdivides into 
 smaller branches forming the Malpighian 
 tufts, which we will describe when speaking 
 of the minute structure of the kidneys. 
 
 The vein rises in the substance of the kid- 
 neys from the capillaries and conveys the 
 blood out of the kidneys into the vena cava. 
 
 2* 
 
18 
 
 BRIGHT'S DISEASE. 
 
 The Nerves of the Kidneys: — These 
 consist of branches from the lower and outer 
 border of the semi-lunar ganglion and the 
 
 Fig. i. 
 Longitudinal section of the kidney, with its renal capsule, i, 
 Renal capsule; 2, cortical or vascular parts of the kidney ; 3. 3, urini- 
 ferous tubes collected into a conical form ; 4, 4, papillae projecting 
 into their corresponding calces; 5, 5, 5, the three infundibula ; 
 6, pelvis of the kidney ; 7, ureter. (After Dr. Morton.) 
 
 solar plexus formed by the descending 
 branches of the small splanchnic nerve. 
 The General Structure of the Kid- 
 
GENERAL STRUCTURE. 19 
 
 neys. — If a kidney be moved from its posi- 
 tion and stripped of its adipose and loose 
 fibrous tissue, we find it completely covered 
 with a capsule, formed of dense fibrous tis- 
 sue, which not only encloses the body of 
 the kidney but is continuous with the pelvis 
 and ureter. If a longitudinal incision be 
 made through its outer border/ we per- 
 ceive that it is composed of two distinct por- 
 tions differing materially in appearance. 
 The external is called the cortical and the 
 internal the medullary portion; the former 
 is about two lines (one-sixth of an inch) in 
 thickness. Its color will depend upon the 
 quantity and character of the blood it con- 
 tains. When normally supplied with healthy 
 blood, it is of a light-red color. In anaemic 
 subjects where there is a deficiency of red 
 corpuscles, it presents a yellowish-white 
 appearance. If we examine the structure with 
 a low magnifying power, we find it made 
 up of secreting tubes called tubuli uriniferi, 
 blood vessels, and Malpighian tufts or glom- 
 erules. In the cortical substance these 
 tubules are very tortuous ; as we descend 
 in the substance of the kidney, they become 
 straight, forming the pyramids of Malpighi. 
 
20 BRIGHT'S DISEASE. 
 
 The medullary substance, or as it is some- 
 times called the tubular portion, of the kid- 
 neys is much less dense than the cortical 
 substance and assumes the form of cones 
 or pyramids with the apices downward, and 
 the bases upward. The apices of these pyra- 
 mids are called mammillary processes or pa- 
 pillce. The number in each kidney varies ; 
 usually, however, there are from twelve to fif- 
 teenin each. Some of them are compound, 
 being formed by the union of two which have 
 a common mammillary termination. The 
 cut surface of a pyramid presents a striated 
 appearance, being composed of tubes, 
 named the tubes of Bellini, who first dis- 
 covered their tubular character. They are 
 united by a fine net-work of fibrous tissue, 
 in which we find associated some large 
 veins which assume a straight course be- 
 tween the tubes. The papillae of each of 
 the cones have several openings, from 
 which the urine escapes into the calces and 
 infundibula. No Malpighian bodies are 
 found in the medullary portion of the kid- 
 neys; they only exist in the cortical sub- 
 stance. 
 
 Pelvis of the Kidney. — This is a strong, 
 
PELVIS OF THE KIDNEY. 
 
 21 
 
 fibrous pouch, divided into three compart- 
 ments, called calces — one at each end, and 
 one intermediate or in the middle. Each 
 
 Fig. 2. 
 
 Vertical section from the cortical 
 surface of the kidney to the apex of 
 one of the medullary cones q, c, 
 bundles of straight tubes passing 
 towards the surface, a, i; the same 
 observed at o and p ; at /, the straight 
 tubes terminate in what is designated 
 Henle's loop and become tortuous ; 
 q, s, t, straight tubes with their 
 dichotomous divisions; h, artery ter- 
 minating in a cluster of Malpighian 
 bodies ; s, apex of one of the medullary 
 cones terminating in a mammillary 
 process or papilla. (After Schum- 
 lausky.) 
 
 one of these calces is again divided into 
 three or four funnel-shaped processes, called 
 infundibula, which embrace the papillae at 
 
22 BRIGHT'S DISEASE. 
 
 their upper or basal extremity. In some 
 anatomical works calces and infundibula are 
 synonymous or convertible terms. From 
 these calces the urine passes into the pelvis 
 of the kidney, which is of a flat, oval form, 
 terminating in the ureter. 
 
 The Ureter. — The ureter is about the 
 size of an ordinary quill, formed of fibrous 
 tissue, lined its entire length by a mucous 
 membrane. It is from fifteen to eighteen 
 inches long, and enters the bladder obliquely, 
 which obliquity answers the part of a 
 valve, preventing a regurgitation of urine 
 after it has passed into the bladder. 
 
 Minute Structure of the Kidneys. — 
 In this division we will consider the follow- 
 ing structures : 
 
 1. Fibro-cellular structure. 
 
 2. The Tubuli Uriniferi, or uriniferous 
 tubes. 
 
 3. Malpighian Tufts, or Glomerules. 
 
 1 . The Fibro-cellular Structure. — This por- 
 tion consists of a fibrous net-work, the 
 meshes of which support the tubes, blood- 
 vessels, nerves, etc., and is therefore the 
 frame-work of the kidneys. It consists of 
 fibro-cellular tissue, and its office is mechan- 
 
MINUTE STRUCTURE. 
 
 23 
 
 ical ; it undergoes no change, and is there- 
 fore regarded as permanent tissue. 
 
 2. The Uriniferous Tubes. — It is diffi- 
 
 Fig. 3 . 
 Microscopic view of secreting structure of the kidney. 1, the 
 renal artery, which at 2 sends a twig to the Malpighian copuscle; 
 3, convoluted tuft, capillary ball or glomerule, enclosed by the cap- 
 sule. The capsule, is seen at 4, and at 5 contracts into a tortuous 
 uriniferous tube or duct of Terrian; 6, the efferent vein bringing 
 back the effete blood, joins the veins 7 and 9 from other capsules, 
 and thus forms the venous capillary plexus around the uriniferous 
 tubes; 8, these capillaries converge and end in the emulgent vein. 
 (After Dr. Morton.) 
 
 cult to trace these tubes from either the 
 cortical substance, or from the apex of the 
 medullary cone. If we commence at the 
 
24 
 
 BRIGHT'S DISEASE. 
 
 latter point, we find them pursuing a com- 
 paratively straight course in the medullary 
 portion of the kidneys [Figs. I and 2], but 
 dividing and subdividing until they reach 
 the cortical substance, when they become 
 very tortuous, and terminate in a closed 
 cavity, very much larger than the tube 
 
 Fig. 4. 
 
 a, The arrangement of the epithelium 
 cells in the tortuous and excretory portion 
 of the uriniferous tubes ; 3, the epithelium 
 arrangement of the cells in the straight or 
 non-excretory portion of the tubes. (After 
 Heidenhain.) 
 
 [see Fig 3]. It is the division and subdi- 
 vision of these tubes that forms the base of 
 the pyramid, and causes it to be uppermost. 
 The spherical enlargement of the tubes 
 is called the capsule, and is 1- 150th of an 
 inch in diameter [see Fig. 3]. The tube 
 below the capsular neck is 1 -480th of an inch 
 in diameter. Their structure is very delicate, 
 consisting of a basement or germinal mem- 
 brane, and an epithelium layer of cells. As 
 
BASEMENT MEMBRANE. 
 
 25 
 
 it is important to make our subject clear 
 to the unprofessional reader, it will be ne- 
 cessary for us to be very exact in our 
 description of this germinal membrane, and 
 the mucous cells that rest upon it [Figs. 
 4 and 5]. This structure was first dis- 
 
 
 Fig. 5. 
 Diagrammatic representation of the basement membrane, and 
 the vital changes that occur in its protoplasma, in the development 
 of epithelium cells ; d, capillary blood-vessels which form the floor 
 of the basement membrane; c, the protoplasma eliminated from the 
 blood-vessels, called the basement membrane or formless matrix; b. 
 the same vitalized by nervo-vital energy, becomes granular, which 
 aggregate and form nuclei ; a, epithelium layer of cells resting 
 upon the outer surface of the so-called basement membrane. 
 
 covered by Bowman and Professor Good- 
 sir; the former named it the basement mem- 
 brane, on account of its being the basis upon 
 which the epithelium and epidermic cells 
 rested, and the latter called it the primary 
 or germinal membrane, believing it to fur- 
 nish the germs of the above named cells. 
 In its most primitive form it te a homoge- 
 
26 BRIGHT'S DISEASE. 
 
 neous fluid layer, so minute that it is inca- 
 pable of measurement. In its more ad- 
 vanced state of development, we find on 
 the upper surface granular particles, upon 
 which rest the epithelium cells. Before 
 these cells are formed the granules unite, 
 forming nuclei, each one of which possesses 
 inherent energy to inclose a portion of the 
 protoplasm of the basement membrane, by 
 the formation of a cell-wall. The nucleus 
 is now enclosed, and is in a condition to 
 impart vito-chemical change to the cell 
 contents. This consists of converting the 
 contents of the cells resting upon the base- 
 ment membrane into the solid constituents 
 of the urine, which is a purely vital process. 
 When this metamorphosis occurs, the life 
 of the cell ceases, and its contents pass into 
 the uriniferous tubes; other cells imme- 
 diately form to take their place. The inte- 
 gration and disintegration of epithelium 
 cells is very rapid, depending, however, 
 upon the amount of fluid blood iliminated, 
 and the vital energy imparted by the 
 organic or sympathetic nervous system. 
 We will show in a future chapter that the 
 office of these cells is to eliminate the morbid 
 
BASEMENT MEMBRANE. 27 
 
 products of decay containing nitrogen. In 
 Bright's Disease the energy imparted by 
 the organic nervous system is impaired, 
 causing a change of function, and if the 
 disease is not arrested, a structural change in 
 the tubes takes place, and finally, completely 
 suspending the office of the kidneys, causes 
 a retention in the blood of nitrogenous 
 products, blood poisoning, and death. YVe 
 thus perceive that the basement membrane 
 is an exudation from the blood, to which 
 the organic nerve filaments are distributed, 
 changing it to a granular form, which sub- 
 sequently unite and form nuclei. The for- 
 mation and character of the epithelium are 
 the same in all glandular structures, yet 
 their functions differ. In the liver they 
 secrete bile, consisting of carbon and hydro- 
 gen ; in the kidneys, urea, etc., containing 
 nitrogen; in the stomach, a gastric juice; 
 in the glands of the mouth, a salivary secre- 
 tion, etc. 
 
 Attached to the outer surface of the epi- 
 thelium cells are hair-like appendages, 
 called cilia [Fig 5]. They vary from 1-5 ooth 
 to i-ioooth of an inch in diameter, and when 
 in motion bend from their attachments in 
 
28 BRIGHT'S DISEASE. 
 
 the cell to their points, returning again 
 to their original state, like a field of wheat 
 when depressed by the wind. Their motion 
 is derived from the nucleus of the cell, and 
 their office is to assist the movements of 
 the products secreted by the cells, their 
 motion being downwards. In some organs, 
 particularly the reproductive of the female, 
 their movements are upwards and inwards. 
 Ciliary motion continues as long as the cell 
 retains its vitality, the motion continuing 
 sometimes after death has apparently oc- 
 curred. It is stated by some writers to 
 continue until decomposition ensues. 
 
 3. Malpighian T?ifts y or Glomerides. — 
 These bodies have been objects of great 
 interest since their discovery by the dis- 
 tinguished anatomist whose name they 
 bear [Fig. 3 and 6]. Malpighi believed 
 them to be internal glands, which could be 
 readily injected from the arterial branches 
 to which they were appended. He also be- 
 lieved the urinary constituents were sepa- 
 rated from the arteries of these bodies, and 
 that the uriniferous tubes were excretory 
 ducts of these glands. Schumlausky was 
 the first to arrive at a correct knowledge of 
 
MALPIGHIAN TUFTS. 
 
 29 
 
 these bodies and their connection with the 
 uriniferous tubes. He described the Mal- 
 pighian bodies as consisting of glomerules 
 of vessels connected on one side with the 
 
 Fig. 6. 
 
 Malpighian body, etc., from 
 the horse, a, arterial branch; /, 
 the arterial twig, or afferent ves- 
 sel ; m, the Malpighian tufts ; f, 
 the vein, or afferent vessel ; at b, 
 its branches enter the medullary 
 cone. (After Bowman). 
 
 arteries, and on the other side with the 
 veins. He further believed there was a' 
 close connection between them and the 
 tubes, but was unable to define it. From 
 1788, the time of Schumlausky's work, to 
 3* 
 
30 BRIGHT'S DISEASE. 
 
 1842, when Mr. Bowman published his 
 paper on the same subject, but little had 
 been added to the knowledge of the Mal- 
 pighian bodies. 
 
 We give Bowman's description of this 
 intricate structure, and the wonderful adap- 
 tation of means to ends, affording undoubted 
 evidence of an infinite Designer. He de- 
 monstrates that the capsule on the upper 
 extremity of the uriniferous tubes is 
 pierced by a twig of the renal artery [Fig. 
 3], which suddenly breaks up into three, 
 four, or eight branches, diverging in all 
 directions, like the petals on the stalk of a 
 flower, and usually assuming a more or less 
 tortuous course, subdividing once, or more, 
 in the formation of the vascular ball or tuft. 
 The vessels resulting from these various 
 divisions are capillaries, with thin, trans- 
 parent, membranous walls. After this com- 
 plex subdivision they twist into a single, 
 small vessel about the size of the arterial 
 twig from which the ball originated. This 
 vessel then emerges from the capsule, near 
 the artery. Both twigs, as they pass in and 
 out, adhere closely to the capsule. This 
 tuft or capillary ball is held together by a 
 
THE CIRCULATION. 31 
 
 mutual interlacement, there being no other 
 tissue admitted into the capsule ; it lies per- 
 fectly loose and bare in its inclosure. Since 
 Bowman's discovery the German and French 
 physiologists particularly have asserted that 
 the glomerules are lined by a delicate 
 mucous membrane, which is the first to 
 undergo a change in Bright's Disease. Be 
 this as it may, the office of the epithelium 
 must be unnecessary for the elimination of 
 the watery portion of urine, which is merely 
 a filtration. 
 
 The Circulation of the Kidneys. — It 
 is important to understand the circulation 
 of the kidneys, in order to familiarize our- 
 selves with their functions, in health and in 
 disease. We have previously stated that 
 the renal artery sends a twig to the capsule 
 of the uriniferous tubes which divide and 
 subdivide, forming a tuft of capillaries. 
 These terminate in a single vessel which 
 passes out of the capsule and anastomoses 
 with branches from other Malpighian bodies, 
 and they form a plexus of capillaries which 
 anastomose around the uriniferous tubes, 
 forming a continuous net-work outside the 
 tubes and in close contact with its basement 
 
32 BRIGHT'S DISEASE. 
 
 membrane. We thus have two sets of 
 capillary vessels in the kidneys, one forming 
 the glomerules, the other the plexus around 
 the tubes [Fig. 3]. This plexus converges 
 and ends in the emulgent or renal vein 
 [Fig. 6] which emerges from the fissure 
 of the kidney and terminates in the vena 
 cava. It is well to note, that arteries con- 
 vey blood to an organ which terminate in 
 capillaries, and the capillaries terminate in 
 veins which convey the blood from an organ. 
 The arteries take blood to tissues and or- 
 gans to supply them with nutrition and the 
 veins take it back to the heart, leaving the 
 products of waste at the excretory organs. 
 When speaking of the function of the kid- 
 neys, we will show that the uriniferous tubes 
 secrete the solid constituents of the urine, 
 and that the Malpighian tufts eliminate the 
 watery portions. The nerves of the kidneys 
 will be explained in a separate chapter in 
 which we shall speak of the vital energy. 
 
CHAPTER II. 
 
 The Nervous System. 
 
 As it is in the nervous system that the 
 vital energy is located, it will not be out of 
 place to devote a short chapter to its struc- 
 ture and functions. All organic structure 
 in which active life exists, has a nervous 
 system of some form ; it may consist of 
 simple granules in a mass of protoplasm, as 
 we find it in the amoeba. Some deny its 
 existence in the lowest organic forms, which 
 are apparently structureless, yet there is 
 evidence of sensibility and automatic action, 
 and as these are only to be found in the 
 nervous system, the inference is that such 
 a system exists in these lower organisms, 
 in a very rudimentary form. The granules 
 are centres of vital energy, which subse- 
 quently become aggregated in nuclei, having 
 the power of forming cells out of proto- 
 plasm. Therefore the most rudimentary 
 form of nervous system consists of granules 
 or corpuscles, possessing a centralizing en- 
 ergy, capable of manifesting motion in un- 
 
 33 
 
34 BRIGHT'S DISEASE. 
 
 organized or structureless protoplasm. As 
 the evolution of forms takes place, the 
 granules aggregate and form nuclei, in 
 which we have the energy increased. In 
 the higher state of organic unfoldment we 
 find the nuclei enclosed by cell-walls, which 
 they have the power of forming. In order 
 to concentrate the energy to meet the re- 
 quirements of higher organic development, 
 ganglia are formed, which are the aggrega- 
 tion of cells, free nuclei, granular particles, 
 albumen, and fatty matter. 
 
 In the Radiata, we find a single ganglion 
 with projecting nerve fibres ; in the Articu- 
 late the form is more complex, and a 
 greater differentiation is required. There 
 are several ganglia joined together by 
 nerves called commissures, and nerves lead- 
 ing to and from the ganglia to different 
 parts of the organism. In the lower types 
 of Vertebrata, a step higher in the evolution 
 of form, we have a spinal system, and a 
 miniature brain, which is gradually un- 
 folded in the successively higher types until 
 perfected in man. We thus perceive that a 
 centre of nervo-vital energy may be a 
 simple granule, a nucleus, or a ganglion. 
 
THE. NERVOUS SYSTEM. 35 
 
 The nerves are entirely different in struc- 
 ture from the ganglia, and possess a very 
 different function. The ganglia are centres, 
 and the nerves are the distributers of energy. 
 A nerve is a minute tube, in the centre of 
 which is a medullary substance, consisting 
 of albumen and fatty matter. Embedded" 
 in this pulpy mass that fills the entire tube, 
 is a delicate fibre, which is the nerve proper, 
 and called the axis cylinder; this central 
 fibre is uniform and continuous, unlike the 
 pulpy mass that surrounds it. Inclosing 
 the medullary mass is a dense, fibrous tis- 
 sue that forms the wall of the tube called 
 the neurilemma, which is continuous with 
 the ganglia, and forms their outer structure. 
 At the peripheral extremity of the nerve 
 the medullary ceases [Fig. 7], in order to 
 expose the nerve fibre to the granular mass, 
 to receive impressions from the external 
 world, and convey them to the centres of 
 consciousness. After the fibre leaves its 
 medullary encasement it forms into an 
 anastomosing loop and returns again to its 
 pulpy covering. When a nerve enters a 
 ganglion it also leaves its medullary envelope, 
 and when it emerges it again receives it, 
 
36 
 
 BRIGHT'S DISEASE. 
 
 showing conclusively that it is the central 
 fibre that is the carrier of energy from the 
 surface of the body to the seat of conscious- 
 ness and that receives energy from the gan- 
 glia and conveys it to different parts of the 
 
 Fig. 7. 
 Looped termination of r.erve fibres in the papillae of the skin, with 
 the granules in which the central nerve fibre communicates. 
 
 system. We thus perceive that the fibre 
 unrobes itself, as it were, to receive energy; 
 when it has done so, it robes itself to retain 
 its energy until it is conveyed to where it is 
 required. The medullary structure com- 
 pletely insulates the fibre, as the cable is 
 insulated that lies at the bottom of the 
 ocean. There is a remarkable similarity 
 between the electro-magnetic battery and its 
 insulated wires and the ganglion and its 
 nerves [Fig. 8]. The ganglion contains 
 cells and nuclei in which is generated nerve- 
 force, and the nerves distribute this force, 
 
THE NERVOUS SYSTEM. 
 
 37 
 
 the same as the electro-magnetic battery 
 generates electro-magnetic force and the 
 wires distribute it. These nerves are dis- 
 tributed to all parts of the body. This can- 
 not be better illustrated than by comparing 
 it to a fine spider's web, the meshes of which 
 
 e 
 
 Fig. 8. 
 Ganglion of the organic or sympathetic nervous system of the 
 mouse, a, b, nerve fibres connecting the adjacent organic ganglia; 
 c, c, c, c, nerve branches to the viscera and spinal nerves; d, gan- 
 glionic cells, the seat of nervo-vital energy ; e % nerve fibres passing 
 through the ganglion receiving energy from the cells. 
 
 are so small that a needle's point could not 
 touch any portion of the soft tissues without 
 injuring one of these nerve fibres. 
 
 The nervous system is divided into the 
 cerebro-spinal (consisting of the brain and 
 4 
 
38 BRIGHT'S DISEASE. 
 
 spinal cord), and sympathetic or organic 
 nervous system. The latter is the first to 
 be developed, appearing in the lowest organic 
 forms and is perfected in the articulated 
 animals. In the vertebrated animals, which 
 follow after the articulated, the spinal sys- 
 tem makes its appearance, and, as we advance 
 in this class, we find the brain gradually bud- 
 ding out or developing from the upper por- 
 tion of the cord, which is not fully unfolded 
 until perfected in man. We regard the 
 nervous system as a unit, having three 
 stages of development. 
 
 I. The sympathetic in which we find 
 many of the functions, which are subse- 
 quently localized in the spinal cord and 
 brain. In the articulated animals in which 
 this first division is developed we find sensi- 
 bility, and automatic action, consciousness, 
 muscular co-ordination, emotions, the sexual 
 passions and instinct, all of which are trans- 
 ferred to the spinal cord and brain when 
 they are separated from the sympathetic 
 nervous system. When the spinal cord is 
 developed, automatic action is transferred 
 to the medulla oblongata, the upper portion 
 of the spinal cord. When the base of the 
 
THE NERVOUS SYSTEM. 39 
 
 brain is unfolded, the seat of consciousness 
 is transferred there. When the cerebellum 
 or posterior of the brain is developed, the 
 emotions, the sexual passions and muscular 
 co-ordination are transferred to it. When 
 the cerebrum or anterior brain is unfolded, 
 we find the mind, which in the lower order 
 of animals is represented by instinct. We 
 thus perceive a gradual differentiation of 
 the nervous system from the lower organic 
 forms to man. These systems are so inti- 
 mately connected that a serious injury 
 occurring in any one of them finds a sym- 
 pathy in the others. 
 
 Notwithstanding the separate functions 
 assigned to each system, there exists a 
 reciprocal. relation; for example, if the pneu- 
 mo-gastric or par-vagum nerve, which con- 
 trols the action of the heart and respiration, 
 be divided, the sympathetic nervous system 
 cannot perform its normal functions, for the 
 blood ceases to circulate, and oxygen, which 
 is essential for chemical change, is not intro- 
 duced into the blood by the lungs. There- 
 fore nutrition, which office is assigned to 
 the organic or sympathetic nervous system, 
 cannot be carried on. If the sympathetic 
 
40 BRIGHT'S DISEASE. 
 
 or organic system should be so impaired 
 that it cannot perform its office, which is 
 the elimination of the products of waste, 
 through the excretory organs and of nutri- 
 tion, the spinal cord and brain must corre- 
 spondingly suffer. The mutual relation exist- 
 ing between the different systems, is brought 
 about by the mingling of the nerves, which 
 so completely anastomose with each other 
 that it is impossible to separate them by the 
 nicest dissection. Paradoxical as it may 
 appear, they are separated yet united. The 
 nerves that concern us the most are the 
 lesser splanchnic and solar plexus, both of 
 which belong to the organic nervous system, 
 and are those which control the functions of 
 the kidneys. The nerves that are distributed 
 to the small arteries and capillaries are the 
 vaso-motor, and their office is to give "tone" 
 to these vessels. They act upon the muscu- 
 lar fibres of the arteries and capillaries, 
 dilating or contracting them according to 
 the stimulus imparted. If we divide the 
 splanchnic nerve, the blood-vessels of the 
 abdominal viscera become dilated, causing 
 congestion. If a stimulus be applied to 
 the same nerve, the same blood-vessels 
 
THE ORGANIC SYSTEM. 41 
 
 become contracted. These vaso-motor 
 nerves come from the splanchnic which is 
 a compound nerve, consisting of nerve-fibres 
 from the sympathetic and spinal nervous 
 systems. The vaso-motor nerves control the 
 function of the Malpighian bodies. The 
 nerves from the solar plexus, which is chiefly 
 a sympathetic nerve, are distributed to the 
 uriniferous tubes and control their function. 
 We thus have two sets of nerves distributed 
 to the kidneys, possessing different func- 
 tions, one to control the elimination of the 
 watery portion of the urine and the other 
 the solid constituents of the same. 
 
 The Sympathetic or Organic Nervous 
 System. 
 Authors have assigned different names to 
 this division of the nervous system. It has 
 been called the " sympathetic nervous sys- 
 tem," the " ganglionic nervous system," 
 the " system of organic life," and the " sys- 
 tem of vegetable life." We prefer the name 
 " organic," on account of its being the seat 
 of energy that unfolds the organism and sus- 
 tains it during its physical existence. In its 
 most rudimentary form, it consists of simple 
 
42 BRIGHTS DISEASE. 
 
 nerve granules ; in its highest develop- 
 ment, of nerve cells, which aggregated 
 together form numerous ganglia. It con- 
 sists of a series of ganglia united together 
 by connecting nerve branches. There are, 
 also, nerves leading from the ganglia to all 
 parts of the organism ; associated with these 
 are nerves from the cerebro-spinal system ; 
 the interlacing of these nerves form what 
 are called a plexus of nerves. The nerve 
 fibres arising in the ganglia, according to 
 Beale, surround the ganglionic cells in a 
 spiral form [Fig. 8.] ; according to Arnold, 
 they penetrate the cells and are attached to 
 the nuclei, the seat of energy. They evi- 
 dently enter the cells, which are very minute, 
 being from I- 1200th to 1 -2000th of an inch 
 in diameter, in order to receive energy. The 
 origin of this nervous system is differently 
 described by anatomists ; some believe it 
 commences in the brain, others in the lower, 
 or coccygial, or sacral region ; others believe 
 it arises in the spinal cord. As its function 
 is separate and distinct from the cerebro- 
 spinal system, its source cannot be consis- 
 tently assigned to brain or cord. Davey 
 believes it to arise from the solar plexus, 
 
THE ORGANIC SYSTEM. 43 
 
 which he designates as the sun and centre 
 of the sympathetic nervous system; but, as 
 this is merely a plexus of nerves and not a 
 centre of nerve energy, it cannot be the 
 source of a system. 
 
 The semi-lunar ganglion, which lies imme- 
 diately below the diaphragm and behind the 
 stomach, is the centre. To describe this sys- 
 tem intelligently : The ganglia are arranged 
 in an oval form, one extremity in the brain, 
 the other in the sacral region, and the centre of 
 this oval is the semi-lunar ganglion. Besides 
 this central ganglion there are six single and 
 twenty-four double ganglia, the former being 
 located in the cranium are called cranial 
 ganglia. They consist of the ganglia of 
 Ribes, the ganglia of Laumonier, the lenti- 
 cular, the phrenopalatine, the otic, and the 
 sub-maxillary ganglia. The twenty-four 
 pairs are called the spinal ganglia, on ac- 
 count of their lying along the spinal 
 column. They are anatomically divided 
 into three servical, twelve thoracic, four lum- 
 bar and five sacral 'ganglia. The semi-lunar 
 ganglion is also double, the right being larger 
 than the left ; it is lobulated which gives it 
 the appearance of a series of ganglia aggre- 
 
44 BRIGHT'S DISEASE. 
 
 gated together and presenting a cribiform 
 appearance. From the upper portion of the 
 semi-lunar ganglion arises a number of nerves 
 which unite with nerves from the 6th, 7th, 
 8th, 9th and 10th dorsal ganglia of the same 
 system, and form the great splanchnic 
 nerve. From the lower portion of the semi- 
 lunar ganglion are given off a number of 
 nerves, which, from their arrangement, have 
 been compared to the rays of the sun. These 
 interlace and form the semi-lunar plexus. 
 Anastomosing with this plexus of nerves 
 are branches of the pneumo-gastric nerve 
 and spinal cord. We will thus perceive 
 that the sympathetic or organic nervous 
 system consists of a series of ganglia, ex- 
 tending from the brain to the sacrum, the 
 centre of which is the semi-lunar ganglion. 
 Each abdominal organ has assigned it a 
 special ganglion from which it is named ; the 
 one assigned to the kidneys is the renal gang- 
 lion, to the liver the hepatic, to the spleen 
 the splenic, to the heart the cardiac, to 
 stomach the gastric, etc., etc. To each one 
 is assigned the special function of the organ 
 to which it belongs, the semi-lunar being 
 the co-ordinating centre. 
 
THE ORGANIC SYSTEM. 45 
 
 Function of the Organic Nervous 
 System. — In man and the higher animals 
 we have two distinct nervous systems; one 
 organic or sympathetic to which is assigned 
 organic life; the other the cerebro-spinal 
 directing animal life. It is the former 
 that concerns us on occount of being the 
 seat of vital energy that unfolds the physical 
 organism from the germinal cell and sustains 
 it through its natural life. It is alluded to 
 by some of the older writers, particularly 
 Hippocrates, Aristotle and Plato, as the life 
 principle manifested in organic forms. Aris- 
 totle and Plato were the first to speak of it 
 as the basis or groundwork, in studying the 
 functions of the human organism. Serres 
 alluding to the researches of Aristotle and 
 Galen, states, "the method of Aristotle is 
 essentially descriptive, neglecting the func- 
 tion for the form. That of Galen essentially 
 natural, neglecting the form for the function. 
 The first of these methods carried in its 
 train the descriptive sciences. The second 
 led to the general sciences. The truth 
 thus lay in their combination and to Haller 
 we owe the merit of having first discovered 
 this fact. He founded his arguments and 
 
46 BRIGHT'S DISEASE. 
 
 opinions upon form and function combined, 
 thus embracing in his method the descrip- 
 tive as well as general sciences." Among 
 the more modern investigators of the organic 
 life principle stands Harvey, who, quoting 
 Moses as authority, locates "the life of the 
 flesh in the blood, for it is the life of the 
 flesh." The inspired writer was right so far 
 as he expresses it, for the blood possesses 
 vitality which is derived from the organic 
 nervous system. Bichat was the first to 
 bring the subject of vital energy out of 
 chaos. He claimed that the vital pheno- 
 mena were of two kinds, one corresponding 
 to those functions by which nutrition and 
 growth of individuals are produced, and the 
 other the reproduction of species — both 
 Common to all living beings — phenomena 
 which bring into existence living forms 
 and sustain them during physical existence. 
 To Bichat also belongs the credit of origi- 
 nating the idea of the independent existence 
 of the organic nervous system. Since his 
 day, similar views have been advanced by 
 Broussais, Gall, Richerand, Wertzer, and 
 Fletcher of Edinburgh. Previous to the 
 publication of Bichat's treatise on the sub- 
 
THE ORGANIC SYSTEM. 47 
 
 ject of life and death, it was generally sup- 
 posed that the entire nervous system was 
 one uniform system. It was from the 
 experiments of Dr. Marshall Hall, that it 
 was fully established that there were three 
 distinct nervous systems, viz. : The brain, 
 spinal cord, and organic or sympathetic. It 
 is somewhat remarkable that Carpenter, 
 Mliller, Todd and Bowman have but little 
 to say about the function of the last named 
 system. This reticence has led to an indif- 
 ference among physicians to the study of the 
 functions of this system in connection with 
 morbid, functional and structural changes 
 in the human organism. It is a well estab- 
 lished fact, with many physiologists and 
 physicians of the present day that the 
 organic nervous system controls nutrition 
 by which the human organism is built up 
 and subsequently sustained. It also con- 
 trols the elimination of disintegrated pro- 
 ducts from the system. 
 
 Is the energy of the organic system vital 
 or physical? It is generally held to be 
 the former. The food used as nourish- 
 ment when first received is dead matter, the 
 energy that combines the molecules being 
 
48 BRIGHT'S DISEASE. 
 
 purely physical. During the process of 
 nutrition it has life imparted to it by the 
 vital energy of the organic nervous system. 
 If this energy be not imparted, it remains 
 crude, lifeless matter, and will be eliminated 
 by the excretory organs, the same as disin- 
 tegrated matter. Every intelligent physi- 
 cian knows that when the vital forces are 
 depressed, the system cannot be properly 
 nourished. In convalescence from a pro- 
 tracted disease, if food be taken that is not 
 digested and assimilated, the patient cannot 
 be restored to health. Restore the vital 
 energy and administer food sparingly, and 
 the patient will gradually recover. It has 
 baffled the penetration of physiologists and 
 physicians to comprehend the nature of the 
 vital principle. Various names have been 
 given to it. Hunter calls it, "materia vitce 
 diffusa;" Hippocrates, "impetum faciens ;" 
 Van Helmont, " archceus ;" Stahl, "amma" 
 The vis medicatrix, or vital principle, is 
 evidently different from the physical energy, 
 being governed by different laws, and mani- 
 festing itself differently in the physical 
 organism. To give a detailed view of its 
 character and source, would require more 
 
THE ORGANIC SYSTEM. 49 
 
 space than is allotted us in this work. We 
 will therefore be compelled to treat it as 
 briefly as possible to be understood. It lies 
 back of the physical, and we must therefore 
 delve into the realms of the unknowable, or 
 unseen universe, where we must study 
 energy and matter in their primitive condi- 
 tions, and trace them from thence to the 
 external world or visible universe. The 
 more nature is studied the less complex 
 she presents herself to our senses, and we 
 are astonished to find how few and simple 
 are her forces and her laws. Simplicity and 
 concentration of purpose appear to be the 
 peculiar features of the all-wise Being in the 
 unfoldment of creation by His will. Com- 
 plexity results from the differentiation of 
 forms by the change of matter from an 
 atomic to a molecular condition. Primary 
 matter, which we call substance (to distin- 
 guish it from physical matter), in its *chaotic 
 state, was motionless, unatomic, without 
 form and void, and therefore engulphed in 
 impenetrable darkness. Incorporated with 
 it were two latent energies, one seeking 
 repose in the centre, the other activity at 
 the periphery, called respectively by the 
 4 
 
50 BRIGHT'S DISEASE. 
 
 ancients, " attractive power" and "repelling 
 motion!' Before motion, light and life made 
 their appearance, or became manifest, these 
 two were brought into juxtaposition by 
 Deity, creating the law of Harmony, when 
 He ordered light to appear. 
 
 By bringing these energies together the 
 substance of chaos was broken up into atoms, 
 and, by the antagonism of the forces, motion 
 was produced, and with it light and life. 
 The atomic substance formed out of the chaotic 
 matter by the antagonism of the twofold force 
 enforced by the law of harmony, and guided by 
 the Divine Will, constituted the beginning of 
 creation. This substance constitutes the mat- 
 ter of the subjective wx>rld out of which the 
 soul is formed; the atomic substance or first 
 matter uniting into molecules constitutes 
 physical matter ; this change in substance 
 is caused by the law of harmony yielding or 
 relaxing to what we term equilibrium, les- 
 sening the energy of the atoms as well as 
 the light manifested by that energy, and 
 thus changing it from an imponderable sub- 
 stance to a ponderable matter, and with it the 
 forces become secondary. This brings us to 
 the objective world with its matter, force, 
 
THE ORGANIC SYSTEM. 51 
 
 and equilibrating law. The forces and mat- 
 ter of the two worlds are distinct, which is 
 entirely owing to the law of harmony becom- 
 ing modified. The conservation of matter 
 and of force, which is a peculiar feature of 
 this world, cannot be carried into the sub- 
 jective, the conservation of substance and of 
 energy of the subjective world cannot be 
 carried into the objective ; but the subjective 
 forces correlate with the objective forces of 
 organic matter. 
 
 In order to make this subject clear to the 
 reader: There was but one original matter 
 which we call substance and from which all 
 matter is derived. There is but one energy in 
 nature, which is twofold, from which all en- 
 ergy is derived ; there is but one law in nature 
 from which all lazv is derived that governs 
 this energy. Light and heat are not forces, 
 but resultants of force. All objective forces, 
 so called by scientists and physicists, are 
 but one force modified by the law of equi- 
 libration. Magnetism, cohesion and chemi- 
 cal affinity, regarded by scientists as three 
 distinct forces, are but one force of a two- 
 fold character in equilibrium. Electricity is 
 the same out of equilibrium ; light is not 
 
52 BRIGHT'S DISEASE. 
 
 visible to the physical eye, it can only be 
 manifested in the simple atomic matter of 
 which the soul is formed. The physical eye 
 only recognizes fire-light, called by the an- 
 cients the " fire-flash!' If the world is ever 
 destroyed it must be by Deity suspending 
 the law of harmony ; if this law should be 
 suspended one moment all cosmical bodies 
 would, in the twinkling of an eye, pass back 
 into chaos. If the reader has been able to 
 follow us, he will perceive that the vital force 
 is purely subjective and unfolds the soul 
 from primary substance, while the physical 
 energy, correlating with the vital, unfolds the 
 physical body. Man thus is a threefold 
 being, a spirit self-encased in the soul and 
 a soul encased in the physical body — and 
 life consists in the correlating of the force 
 of the soul and the organic force of the 
 physical body. Now, we will submit the 
 question : What is the vital energy of the 
 physical organism ? It is the energy of the 
 soul correlating with the energy of the nerv- 
 ous system, the former directing the unfold- 
 ment of the physical organism in accord- 
 ance with the type and form of the soul, 
 the physical body being the outward form 
 
THE ORGANIC SYSTEM. 53 
 
 of the man — the external expression of a 
 spiritual organism. This makes the physi- 
 cal forces of organic matter subordinate to 
 the vital, and the energy sustaining physical 
 life a nervo-vital force. At death, the 
 latter withdraws, correlation has ceased, and 
 the physical takes possession of the organic 
 matter and reduces it to its normal chemi- 
 cal constituents. The correlation of the 
 vital and physical forces takes place in the 
 nervous system ; so long as harmony exists 
 between them there is normal life-action. 
 When discord exists we have disease which 
 may be of a structural or functional charac- 
 ter. The nervous system is the physical 
 medium through which the spirit and soul 
 communicate with the external world. The 
 brain is devoted to psychical, emotional, sen- 
 sational properties of the spirit, and the or- 
 ganic nervous system to growth, repair and 
 elimination of waste from the organism. 
 
 What is disease ? It is an impairment or 
 ennervation of the nervo-vital energies, oper- , 
 ating in and through the organic or sympa- 
 thetic nervous system, leading to functional 
 derangement or structural changes in the 
 organism. The cause of impairment of 
 
54 BRIGHT'S DISEASE. 
 
 physical health is not dependent upon relax- 
 ing of the soul's energy, but on the disturb- 
 ance of the correlation of the nervo-vital 
 forces. The physical organism is merely a 
 dwelling-place for the soul during the spirit's 
 individualization in matter and spiritual pro- 
 bation. The period assigned for man's 
 spiritual probation is three score and ten 
 years ; yet how few attain to it, owing to 
 heriditary and acquired causes, impairing the 
 organic nervous system and its energies, 
 and thus preventing the Spirit from sustaining 
 physical life. We shall fully elaborate this 
 subject in a work we are now preparing for 
 the press, entitled, Life, What itis y Its Source 
 and How it may be Prolonged. 
 
CHAPTER III. 
 
 Function or Office of the Kidneys. 
 
 The office of the kidneys is to eliminate 
 some of the morbid products of the blood, 
 the result of disintegration, which is 
 momentarily taking place in the physical 
 organism. The arteries convey the blood 
 to the capillaries to supply the waste that 
 is taking place in the system. The veins 
 receive from the capillaries the blood which 
 contains the product of decay, and convey 
 it to the different eliminating organs, where 
 it is thrown off. The scavengers or puri- 
 fiers of the blood are the kidneys, lungs, 
 liver, the glands of the alimentary canal 
 and skin. The capillaries are thus the car- 
 riers of the blood to the various tissues and 
 organs, to supply the waste that is continu- 
 ally occurring, and they also take up the 
 products of decay and convey them with the 
 blood to the veins. The office of the kid- 
 neys is to eliminate the azotized or nitro- 
 genized products; the liver the carbo-hy- 
 drogen, and the lungs carbonic acid. If 
 
 55 
 
56 BRIGHT'S DISEASE. 
 
 these decayed elements should be retained 
 in the blood a short time, they poison the 
 nervous centres, and cause death. It is 
 therefore of the utmost importance that the 
 eliminating organs should be in a healthy 
 and active condition, to cleanse the blood 
 of these morbid products. The great secret 
 of health is to take into the system suf- 
 ficient food, and no more, to compensate 
 for the waste, and to keep the excretory or- 
 gans in a healthy condition, to remove the 
 impurities from the blood. If we could 
 maintain this balance (in a normal or healthy 
 constitution) between repair and waste, and 
 not overtax our vital energies, there would 
 be no difficulty in attaining to the age alot- 
 ted to man, if not going considerably beyond 
 it. In order to understand the functions of 
 the kidneys, it will be necessary for us to 
 familiarize ourselves with the structure, 
 which we have fully described in a previous 
 chapter. It is in the Malpighian tufts and 
 uriniferous tubes of the cortical portion of 
 the kidney where this function is performed. 
 Dr. Bowman in an essay, published in 1842, 
 was the first to advance a true theory of 
 the function of this portion of the kidney. 
 
OFFICE OR FUNCTION. 57 
 
 On account of the clearness with which he 
 has presented this subject, we think it ad- 
 visable to quote him : — 
 
 " Reflecting on this remarkable structure 
 of the Malpighian bodies, and their singular 
 connection with the tubes, I was led to 
 speculate on their use. It occurred to me 
 that as the tubes and their plexus of capil- 
 laries were probably, for reasons presently 
 to be stated, the parts concerned in the se- 
 cretion of that part of the urine to which its 
 characteristic properties are due (the urea, 
 lithic acid, etc.), the Malpighian bodies 
 might be an apparatus destined to separate 
 from the blood the watery portion. This 
 view, on further consideration, appears so 
 consonant with facts, and with analogy, 
 that I shall in a few words state the reasons 
 that have induced me to adopt it. I am 
 not unaware how obscure are the regions 
 cf hypothesis m physiology, and shall be 
 most ready to renounce my opinion if it 
 should be shown to be inconsistent with 
 truth. 
 
 " In extent of surface, external structure, 
 and the nature of its vascular net-work, the 
 membrane of the uriniferous tubes corre- 
 
58 BRIGHT'S DISEASE. 
 
 sponds with that forming the secreting sur- 
 face of other glands. Hence it seems cer- 
 tain that this membrane is the part specially 
 concerned in eliminating from the blood the 
 peculiar principles found in the. urine. To 
 establish this analogy, and the conclusions 
 deduced from it, a few words will suffice: 
 I. The extent of surface obtained by the in- 
 volution of this membrane will by most be 
 regarded as its self-sufficient proof. 2. Its 
 internal surface is conclusive. Since epi- 
 thelium has been found by Purkinje and 
 Henle in such enormous quantities on the 
 secreting surface of all true glands, its use 
 cannot be considered doubtful. It never 
 forms less than I9~20ths of the thickness of 
 secreting membrane, and in the liver it even 
 seems to compose it entirely, for there I 
 have searched in vain for a basement tissue 
 like that which supports the epithelium in 
 other glands. The epithelium, thus chiefly 
 forming the substance of secreting mem- 
 brane, differs in its general characters from 
 other forms of this structure. Its nucleated 
 particles are more bulky, and appear from 
 their refractive properties to contain more 
 substance, their internal tissue being very 
 
OFFICE OR FUNCTION. 59 
 
 finely mottled when, seen by transmitted 
 light. In these particles the epithelium of 
 the kidney tubes is eminently allied to the 
 best marked examples of glandular epi- 
 thelium. 3. The capillary net-work surround- 
 ing the uriniferous tubes is the counterpart 
 of that investing the tubes of the testes, 
 allowance being made for the difference in 
 the capacity of these canals in the two 
 glands. It corresponds with that of all true 
 glands in lying on the deep surface of the 
 secreting membrane, and its numerous ves- 
 sels everywhere anastomosing freely with 
 one another. 
 
 "These several points of identity may 
 seem too obvious to be dwelt upon, but I 
 have detailed them in order to show that, 
 in all these respects, the Malpighian bodies 
 differ from the secreting parts of true 
 glands. 1. The Malpighian bodies com- 
 prise but a small part of the inner surface 
 of the kidney, there being but one to each 
 tortuous tube. 2. The epithelium immedi- 
 ately changes its character as the tube 
 expands to embrace the tuft of vessels. From 
 being opaque and minutely mottled, it 
 becomes transparent, and assumes a definite 
 
60 BRIGHT'S DISEASE. 
 
 outline; from being bald it becomes covered 
 with cilia (at least in reptiles, and probably 
 in all classes) ; and in many cases it appears 
 to cease entirely a short way within the 
 neck of the Malpighian corpuscle. 3. The 
 blood-vessels instead of being on the deep 
 surface of the membrane, pass through it, 
 and form a tuft on its free surface. Instead 
 of the free anastomoses elsewhere observed, 
 neighboring tufts never communicate, and 
 even the branchlets of the same tuft remain 
 quite isolated from one another. 
 
 "Thus the Malpighian bodies are as 
 unlike, as the tubes passing from them are 
 like, the membrane which, in other glands, 
 secern its several characteristic products 
 from the blood. To these bodies, there- 
 fore, some other and distinct function is 
 with the highest probability to be attri- 
 buted. 
 
 " When the Malpighian bodies were con- 
 sidered merely as convoluted vessels, with- 
 out any connection with the uriniferous 
 tubes, no other office could be assigned 
 them than that of delaying the blood in its 
 course to the capillaries of the tubes, and 
 the object of this it was impossible to ascer- 
 
OFFICE OR FUNCTION. 61 
 
 tain. Now, however, that it is proved that 
 each one is situated at the remotest ex- 
 tremity of the tube, that the tufts of the 
 vessels are a distinct system of capillaries 
 inserted into the interior of the tube, sur- 
 rounded by a capsule formed by its mem- 
 brane, and closed everywhere except at the 
 orifice of the tube, it is evident that conjec- 
 tures on their use may be formed with 
 greater plausibility. 
 
 " The peculiar arrangement of the vessels 
 in the Malpighian tufts is clearly designed 
 to produce a retardation in the flow of blood 
 through them, and the insertion of the tuft 
 into the extremity of the tube is a plain 
 indication that this delay is subservient in a 
 direct manner to some part of the secretive 
 process. 
 
 " It now becomes interesting to inquire, 
 in what respect the secretion of the kidney 
 differs from that of all other glands, that 
 so anomalous an apparatus should be 
 appended to its secreting tubes. The differ- 
 ence seems obviously to lie in the quantity 
 of aqueous particles contained in it, for how 
 peculiar soever to the kidney the proximate 
 principles of the urine may be, they are not 
 
62 BRIGHT'S DISEASE. 
 
 more so than those of other glands to the 
 organs which furnish them. 
 
 " This abundance of water is apparently- 
 intended to serve chiefly as a menstruum 
 for the proximate principles and salts which 
 this secretion contains, and which, speaking 
 generally, are far less soluble than those of 
 any other animal product. This is so true, 
 that it is common for healthy urine to 
 deposit some part of its dissolved contents 
 on cooling. 
 
 " If this view of the share taken by the 
 water be correct, we must suppose that 
 fluid to be separated either at one point of 
 the secreting surface along the proximate 
 principles, as has hitherto been imagined, 
 or else in such a situation that it may at 
 once freely irrigate the whole extent of the 
 secerning membrane. Analogy lends no 
 countenance to the former supposition; 
 while to the latter, the singular position and 
 all the details of the structure of the Mal- 
 pighian bodies, gives strong credibility. 
 
 " It would, indeed, be difficult to conceive 
 a disposition of parts more calculated to 
 favor the escape of water from the blood 
 than that of the Malpighian body. A large 
 
OFFICE OR FUNCTION. 63 
 
 artery breaks up, in a very direct manner, 
 into a number of minute branches, each of 
 which suddenly opens into an assemblage 
 of vessels of far greater aggregate capacity 
 than itself, and from which there is but one 
 narrow exit. Hence must arise a very ab- 
 rupt retardation in the velocity of the cur- 
 rent of blood. The vessels in which this 
 delay occurs are uncovered by any struc- 
 ture. They lie bare in a cell from which 
 there is but one outlet, the orifice of the tube. 
 This orifice is encircled by cilia in active 
 motion, directing the current to the tube. 
 These exquisite organs must not only serve 
 to carry forward the fluid already in the 
 cell, and in which the vascular tube is 
 bathed, but must tend to remove pressure 
 from the free surface of the vessels, and so 
 to encourage the escape of their more fluid 
 contents. Why is so wonderful an appara- 
 tus placed at the extremity of each urinife- 
 rous tube, if not to furnish water to aid in 
 the suppuration and solution of the urinous 
 products from the epithelium of the tube ?" 
 The theory advanced by Dr. Bowman 
 that the uriniferous tubes secrete the solid 
 constituents of the urine, is verified by ex- 
 
64 BRIGHT'S DISEASE. 
 
 amining the urine of the boa y which is 
 almost solid. The solidity of the urine of 
 the boa is owing to the artery supplying the 
 kidneys being very small compared with 
 other animals, and eliminating but a very 
 small quantity of water, barely sufficient to 
 carry off the solid material secreted by the 
 tubes. Observations made by Dr. Johnson 
 are also confirmatory of Dr. Bowman's 
 theory. He states : " In examining the kid- 
 neys of a person who died with jaundice, 
 and in whose urine there had been a large 
 quantity of bile, I observed that the tubes 
 were stained of the deep yellow color of bile 
 in their epithelial cells, and that the yellow 
 color ceased absolutely at the neck of the 
 Malpighian corpuscle, and in no one instance 
 did it affect any part of the tissues of the 
 Malpighian bodies." We may therefore 
 conclude, without further testimony from 
 the observations of Dr. Bowman and the 
 confirmation of modern physiologists, that 
 the solid constituents of the urine are 
 secreted by the uriniferous tubes of the kid- 
 neys. The straight portion of the tubes of 
 the pyramid have no secreting power as- 
 signed them, although they are lined by the 
 
OFFICE OR FUNCTION. 65 
 
 same character of epithelium as the cortical 
 portion. They are merely excretory ducts 
 for the purpose of conveying off the excre- 
 tory products of the tortuous portion of the 
 tubes and the water eliminated by the Mal- 
 pighian bodies into the pelvis of the kidneys. 
 The kidneys perform another important 
 office in the human economy, besides elimi- 
 nating nitrogenized products. They act as 
 a safety-valve in regulating the quantity of 
 water in the blood. They, with the lungs 
 and skin, are the only means through which 
 the system has the power of removing the 
 water from the blood. The amount of fluid 
 that passes off in the form of insensible 
 perspiration and by the lungs, according to 
 Seguin, is eighteen grains per minute, eleven 
 grains of which is thrown off by the skin 
 and seven grains by the lungs. The maxi- 
 mum quantity eliminated by the skin and 
 lungs in twenty-four hours is five pounds, 
 and the minimum quantity, one pound and 
 two-thirds. The exhalation of the skin 
 varies according to the condition of the 
 atmosphere ; when it is moist, it is dimin- 
 ished, when dry, it is increased. When the 
 temperature is high and the atmosphere dry, 
 5 
 
66 BRIGHT'S DISEASE. 
 
 a large amount of moisture is thrown off 
 in the form of sensible perspiration, and 
 with it there escapes a large amount of free 
 caloric relieving the system from oppression 
 which might otherwise occur. We are all 
 aware of the relief free perspiration affords 
 in extremely warm weather, and how soon 
 a simple fever may be broken up by induc- 
 ing a copious perspiration. For many 
 years, I have been in the habit of breaking 
 up catarrhal and remittent fevers by bring- 
 ing about a free perspiration and keeping it 
 up until the fever subsides, which it will 
 usually do in from six to twenty-four hours. 
 In this plan of treatment the head should 
 always be kept cool by the application of 
 ice. 
 
 Several years ago, when the relapsing- 
 fever prevailed in Philadelphia, the crisis 
 was brought about on the seventh day by 
 Nature causing the patient to perspire co- 
 piously, and the kidneys to act freely. If 
 the first attack, the patient would be appa- 
 rently well and out in from twenty-four to 
 forty-eight hours, to be again stricken 
 on the seventh day, with the symtoms 
 aggravated, and when repeated the third time, 
 
PERSPIRATION. 67 
 
 it was generally fatal. After losing one 
 case during the third attack, I anticipated Na- 
 ture by producing at the commencement of 
 the disease a copious perspiration, and keep- 
 ing it up for forty-eight hours. I never lost 
 a case afterwards, neither did I have any cases 
 to relapse. It is by perspiration of the skin 
 that we get rid of the free caloric, which, if 
 retained, brings about congestion of some 
 one of the internal organs. What is com- 
 monly known as coupe de soldi, or sunstroke, 
 is the overheating of the blood, producing 
 cerebral congestion. We thus perceive the 
 danger of suddenly checking perspiration, 
 which is frequently and ignorantly done by 
 sitting in a draught, or by removing superflu- 
 ous clothing, when overheated. The blood- 
 vessels of the skin become contracted by sud- 
 den change of temperature, forcing as uper- 
 abundance of blood upon the kidneys or 
 lungs, etc., causing congestion. Most per- 
 sons are aware that less water is passed by 
 the kidneys in summer than in winter. This 
 is owing to the blood-vessels becoming 
 contracted, and perspiration lessened, caus- 
 ing the blood to be directed toward the 
 kidneys, producing a more rapid discharge 
 
68 BRIGHT'S DISEASE. 
 
 of water from the Malpighian bodies. Per- 
 sons affected with Bright's Disease should 
 be exceedingly careful to protect the sur- 
 face of the body in summer as well as in 
 winter, for fear of increasing congestion of 
 the urinary organs, which always attends 
 Bright's Disease. Cutaneous perspiration 
 has no influence on the amount of solid 
 matter secreted by the kidneys ; it depends 
 upon the waste taking place in the system, 
 and the excess of food taken to supply the 
 wants of nutrition. When there is too much 
 to compensate for the waste, the excess 
 is not assimilated, but undergoes rapid 
 retrograde metamorphosis, and must be 
 eliminated by some one of the excretory 
 organs. It is by excess of feeding, and 
 the drinking of spirituous liquors, that the 
 gormandizer and inebriate overtax the 
 liver and kidneys, producing either organic 
 or functional disease, and leading to much 
 suffering, if not to premature death. 
 
 Under ordinary circumstances, each ex- 
 cretory organ is limited to its own special 
 function, yet there are certain complementary 
 relations between them which enable them 
 to render assistance to each other. For 
 
VICARIOUS EXCRETIONS' 
 
 69 
 
 example, when respiration is active, the 
 lungs eliminate more carbonic acid, and the 
 liver secretes less bile, it consisting largely 
 of carbon. If respiration be diminished, 
 there is less carbon thrown off by the 
 lungs, which is eliminated with hydrogen, 
 in the form of bile. We find similar com- 
 plementary relations existing between the 
 skin and the kidneys, to which w T e have 
 already alluded. While speaking of the 
 mutual relations existing between the dif- 
 ferent organs, it will not be out of place to 
 allude to what are called vicarious excre- 
 tions. It is the metastasis or removal of an ex- 
 cretion from its natural outlet through some 
 organ possessing entirely different func- 
 tion. For example, urine has been known 
 to have been eliminated from the bowels, 
 eyes, breast (of the female), stomach, mouth, 
 nose, ears, skin, etc. Dr. Lacock has col- 
 lected a large number of such cases, which 
 we give in the following table : — 
 
 124 
 
 A familiar form of excretory metastasis is 
 
 "3 
 
 *o 
 
 ifl 
 
 w 
 
 ci 
 
 <u 
 
 C/5 
 
 > 
 
 c 
 
 
 
 > 
 
 
 
 & 
 
 
 
 
 
 52! 
 
 M 
 
 £ 
 
 01 
 
 33 
 
 20 
 
 4 
 
 4 
 
 5 
 
 3 
 
 4 
 
 34 
 
 17 
 
70 BRIGHT'S DISEASE. 
 
 found in jaundice, where the bile is secreted 
 by the liver, absorbed in the blood, and 
 eliminated by the skin, kidneys, etc. 
 
 Secretion of Urine. — To understand 
 the morbid condition of the urinary organs, 
 we must be familiar with their normal func- 
 tions. Fresh, healthy urine is a clear, am- 
 ber yellow liquid, and of a peculiar, dis- 
 agreeable odor, with a well marked acid 
 reaction. If permitted to stand some time 
 a slight cloudiness appears, consisting of 
 mucus, which gradually settles at the bot- 
 tom of the vessel. Very soon a different, 
 more unpleasant odor is developed, when 
 the urine becomes alkaline, which is owing 
 to the decomposition of urea into carbonate 
 of ammonia, and a precipitate of earthy 
 phosphates. 
 
 Healthy urine may become turbid soon 
 after being passed, on cooling, which is due 
 to the precipitation of urates of soda and 
 ammonia, which are very soluble in warm 
 water, but insoluble in cold water. It is 
 only when they are slightly in excess that 
 they are precipitated. If the urine should be 
 turbid 07t passing it is considered abnormal. 
 The quantity of urine passed in twenty-four 
 
AMOUNT OF URINE. 71 
 
 hours varies, depending upon the amount 
 of liquid taken into the system, and the ex- 
 ternal temperature. If the surface of the 
 body should be chilled, and perspiration 
 become partially checked, there is more 
 water passed by the kidneys. According 
 to the observations of Dr. Prout, about 
 30 ounces is the amount passed in summer, 
 and 40 ounces in winter. The specific grav- 
 ity of urine varies with the amount of solid 
 food taken, and the amount of waste going 
 on in the organism. The average, taking 
 the whole year, according to the same 
 writer, is about 1020, rising in summer to 
 1025, and falling in winter to 1015. This 
 variation, as we have previously stated, is 
 owing to the much larger amount of fluid 
 eliminated by the skin during the warm 
 summer months in the form of perspiration 
 than during the cold, chilly months of fall, 
 winter and spring. 
 
 The amount of solid matter in 1000 parts 
 of urine fluctuates widely, the difference 
 being due to diet, waste taking place in the 
 system, and the amount of water eliminated. 
 
 The following tables have been construc- 
 ted by Simon, from Leeman's Analysis: 
 
72 
 
 BRIGHT'S DISEASE. 
 
 Urine. 
 
 Amount in 24 Hours . . . 
 
 Specific Gravity 
 
 Solid Residuum from 1000 Parts 
 
 of Urine Passed .... 
 Solid Matter Passed in 24 
 
 Hours 
 
 Mixed 
 Diet. 
 
 IO57.8 
 I022. 
 
 65.82 
 67.82 
 
 Animal 
 Diet. 
 
 Grammes. 
 
 I202.5 
 
 IO27.I 
 
 7548 
 87.44 
 
 Vegeta- 
 ble Diet. 
 
 Grammes. 
 
 909. 
 
 IO27.5 
 
 66.4I 
 
 59-23 
 
 Urea. 
 
 In 100 parts of 
 solid residuum. 
 
 Daily amount 
 in grammes. 
 
 During a mixed diet, . . 
 During an animal diet, 
 During a vegetable diet, . 
 
 46.230 
 61.297 
 39.086 
 
 32.498 
 53.198 
 22.481 
 
 Uric Acid. 
 
 In 100 parts of 
 solid residuum. 
 
 Daily amount 
 in grammes. 
 
 During a mixed diet, . 
 During an animal diet, . 
 During a vegetable diet, . 
 
 1. 7IO 
 
 I.674 
 
 ^•737 
 
 1. 183 
 1.478 
 I.02I 
 
 It will be observed from these tables that 
 the amount of urea is always diminished 
 by vegetable diet, while the quantity of 
 uric acid is not materially affected. A 
 knowledge of this fact is of the utmost im- 
 portance in the treatment of Bright's Dis- 
 ease. Vegetable diet considerably increases 
 the amount of extractive matter, which is 
 diminished in animal diet. The amount of 
 
 *A gramme is equal to 15.4 grains Troy. 
 
CONSTITUENTS. 
 
 73 
 
 phosphates, lactic acid and lactates are but 
 slightly changed by an animal or mixed 
 diet. 
 
 Constituents. 
 
 Solid constituents, . 
 
 Urea, 
 
 Uric Acid, . . . 
 Lactic Acid and Lactates, 
 Extractive matters, . 
 
 
 
 
 Grammes 
 
 Grammes 
 
 Grammes 
 
 67.82 
 
 8744 
 
 59.24 
 
 32.5O 
 
 53 20 
 
 22.48 
 
 I.I8 
 
 I.48 
 
 I.02 
 
 2.72 
 
 2.17 
 
 2.68 
 
 IO.49 
 
 5.20 
 
 16,50 
 
 fc=a 
 
 Gr mes 
 44.68 
 15.41 
 0.73 
 
 5.82 
 
 11.85 
 
 We observe that urine consists of a 
 liquid and solids, which are produced by 
 two distinct structures, but closely united. 
 They comprise the Malpighian bodies and 
 uriniferous tubes, the functions of which we 
 will speak of separately. 
 
 1 . Malpighian Bodies. — The Malpighian 
 tufts or glomerules consist of capillaries 
 twisted upon themselves, forming a round 
 mass or ball, and enclosed within the upper 
 and dilated portions of the uriniferous tubes 
 [Figs. 3 and 4]. These capillary vessels are 
 minute tubes lying between the arteries and 
 veins, and so numerous that it would be im- 
 possible to insert the point of a needle in 
 
74 BRIGHT'S DISEASE. 
 
 any part of the soft tissues without injuring 
 them. It will not be amiss here to state, 
 briefly, the relation existing between the 
 capillaries, arteries and veins. The arteries 
 arise from the ventricles of the heart in two 
 branches, one going to the lungs, and called 
 the pulmonary artery, the other to the gen- 
 eral system, called the aorta. They divide 
 and subdivide, and finally terminate in 
 capillaries. The veins arise from the capil- 
 laries and convey the blood back to the 
 heart ; the capillaries are, therefore, a con- 
 necting link between the arteries and veins. 
 All of these vessels have elastic walls, con- 
 sisting of muscular fibres and muscular cells, 
 which are well defined in the large arteries, 
 but gradually diminish as they emerge into 
 the capillaries, whose walls are exceedingly 
 thin and permeable, permitting the fluid por- 
 tion of the blood to pass through them into 
 the surrounding tissues or " lymph space." 
 There is a normal constriction in the capillary 
 walls which limits the amount of fluid passing 
 through them. The area of the aorta is 
 much less than the area of its branches. 
 Vierodt has estimated the area of the capil- 
 laries, and makes them several hundred 
 
RELATIONS OF NERVES. 75 
 
 times larger than the area of the aorta. 
 They may be compared to an inverted fun- 
 nel, with its apex at the aorta. To the 
 arteries and capillaries are distributed nerve 
 fibres, called vaso-motor nerves. These 
 nerves control the calibre of the capillaries, 
 as we have shown in a previous chapter. If 
 there is a deficiency of nerve-energy, the 
 walls are relaxed, circulation sluggish, and 
 the parts assume an increased redness. The 
 emotions frequently bring about this condi- 
 tion, producing what is called " blushing." 
 The opposite condition takes place in what 
 is called " palor." If the splanchnic nerve 
 be divided, the walls of the capillaries sud- 
 denly relax, followed by a copious filtering 
 of water from the blood, as in hydrura or 
 poly-urea. If a stimulus be applied to the 
 divided nerve, the relaxation of the tufts is 
 overcome and the copious flow ceases. An 
 injury to the cerebellum will give rise to an 
 increased flow of urine ; a puncture of the 
 fourth ventricle of the brain or a mechanical 
 injury to the fourth thoracic ganglion causes 
 a large quantity of sugar to appear in the 
 urine, with a rapid increase of fluid. This 
 is known as artificial diabetes. Injuries to 
 
76 BRIGHT'S DISEASE. 
 
 the pneumo-gastric or par-vagum nerve, or 
 to the medulla oblongata cause a rapid flow 
 of urine. These injuries impair the func- 
 tion of the vaso-motor nerves, which are 
 branches of the splanchnic nerve, containing 
 motor fibres from the spinal cord. From 
 what has been stated, it can readily be per- 
 ceived that the vaso-motor nerves are spinal 
 branches associated with sympathetic nerve 
 branches, controlling capillary circulation, 
 and, therefore, modifying the quantity and 
 character of the water eliminated by the 
 Malpighian tufts, which is not a secretion, 
 but simply a filtration through the capillary 
 walls. We have, then, two sets of nerves 
 distributed to the kidneys : one vaso-motor, 
 which are inhibitory and come from the 
 spinal system, and yet are associated with the 
 splanchnic nerve, a branch of the sympa- 
 thetic, and nerves from the solar plexus 
 which control the secretion of the urinife- 
 rous tubes. It is believed, and so stated, 
 by physiologists, that filtration depends 
 upon arterial pressure. It may, to a limited 
 extent. The arrangements of the capillaries 
 in forming the glomerules is to economize 
 space and give more filtering surface. In 
 
URINIFEROUS TUBES. 77 
 
 the boa, the renal artery is very small, and 
 the glomerules correspond in size with the ' 
 artery. The vaso-motor nerves give tone to 
 the walls of the capillaries, which a moder- 
 ate irritation increases. If pushed too far, 
 the nerve becomes exhausted and relaxation 
 ensues, the tone is gone, and the filtration 
 of water is increased. I am, therefore, of 
 the opinion that arterial pressure does not 
 facilitate filtration in the glomerules, but 
 relaxation of the capillary walls, by a dimi- 
 nution of vaso-motor energy, causes it. 
 
 2. Uriniferons Tubes. — We have shown 
 that the office of the Malpighian bodies is 
 to eliminate the superabundance of water in 
 the blood which is accomplished by a pro- 
 cess of filtration through the walls of the 
 capillary tufts; the quantity eliminated 
 depending upon the tonicity of the walls, 
 imparted by the vaso-motor energy. 
 
 The function of the uriniferous tubes is 
 very different from that of the Malpighian 
 tufts, being performed by an epithelium 
 structure resting on the basement mem- 
 brane and lining the tubes. The office is 
 one of excretion, and is a nervo-vital pro- 
 cess, the energy being imparted through 
 
78 BRIGHT'S DISEASE. 
 
 the solar plexus. In the kidneys there are 
 two perfectly distinct systems of capillary 
 vessels. The first consists of the Malpighian 
 tufts which are immediately connected with 
 the arteries. The second envelopes the 
 uriniferous tubes, forming a plexus around 
 the tubes and so arranged as to form a basis 
 for the basement membrance of the tubes ; 
 the capillaries then terminate in veins 
 [Fig. 3]. We have already given a descrip- 
 tion of this membrane in a previous chap- 
 ter, and all that is necessary to say here, is 
 that the material of which it is composed is 
 an elimination from the capillaries, which, 
 undergoing a vital change from energy 
 imparted by the ganglionic nervous sys- 
 tem, causes the exuded fluid to become 
 granular. These granular particles unite 
 to form the nuclei, and these possess the 
 inherent vital energy to construct the epi- 
 thelium cells that rest upon the basement 
 membrane. Nerve fibres have been traced 
 into this membrane, and are supposed to 
 extend up into the epithelium cells and to 
 be attached to the nuclei. This is not requi- 
 site; the nerve fibres convey an energy to 
 the blood lymph that is eliminated from the 
 
CELL CHANGES. 79 
 
 capillaries, and in revitalizing it produce 
 the granular particles which aggregate and 
 form muclei, and the muclei possess the 
 power to create cells. Therefore, all that 
 is necessary is for the nerves to enter the 
 fluid mass and create vitalizing centres, 
 which are the granules. All secretory and 
 excretory cells are frequently removed, for 
 as soon as the cell contents are changed 
 into the solid constituents of the urine the 
 cell disintegrates and another immediately 
 takes its place from the basement mem- 
 brane. In all secreting and excreting 
 organs, the formation and disintegration of 
 cells depend upon the activity of the func- 
 tions of the organ. In the stomach, during 
 digestion and in the villi of the intestines 
 during the absorption of chyle, the func- 
 tions are exceedingly active, and the forma- 
 tion and disintegration of cells is very rapid. 
 The change of cells in the kidney tubes 
 depends upon the amount of serum elimi- 
 nated from the vessels, and the amount of 
 nerve energy imparted to it. For example, 
 in fevers and inflammatory condition of the 
 kidneys both are increased, and a greater 
 amount of solid constituents is excreted and 
 
80 BRIGHT'S DISEASE. 
 
 therefore a more rapid formation and disin- 
 tegration of cells must take place. If this 
 vital nerve energy should be diminished, 
 and less blood serum be eliminated, the 
 specific gravity of the urine becomes les- 
 sened, owing to a diminution of the solid 
 constituents. We may regard all epithelium 
 cells in any part of the system as small labora- 
 tories and the work-master or chemist the 
 nucleus. If the master be sick or out of 
 sorts (and this will depend upon the condi- 
 tion of the nervous system that gives him 
 his energy) the work is imperfectly per- 
 formed and the result, disease. In proof 
 that the nervous system is the source of 
 energy, by stimulating the nerve branches 
 of a gland the secretion is rapidly increased 
 and is much richer in constituents. If the 
 nerve fibres be divided the secretion stops 
 entirely, or becomes very fluid. We shall 
 show when we speak of the cause of Bright's 
 Disease, that in the organic nervous system 
 lies the cause of this much dreaded and 
 inveterate malady. If a solution of indigo- 
 carmine be injected into the veins of the 
 kidneys of an animal in which the urinary 
 flow has been arrested by an incision of 
 
UNANSWERED QUESTION. 81 
 
 the medulla oblongata, the carmine will be 
 found to have passed through the walls of 
 the capillaries, and been diffused through the 
 basement membrane, taken up by the cells 
 and eliminated into the tubes. No trace of 
 it, however, can be found in the Malpighian 
 tufts. This shows the method nature adopts 
 for the elimination of morbid products from 
 the blood which is accomplished through 
 cell structure, resting upon and formed from 
 a basement membrane. The uriniferous 
 tubes are secretory glands, taking from the 
 blood lymph, eliminated by the capillaries, 
 the waste products and by nervo-vital 
 chemistry changing them into urea, uric 
 acid, extractive matter, etc. 
 
 How are the disintegrated products of 
 the tissues, which are so varied, distributed 
 by the blood-vessels to the organs assigned 
 . for their elimination ? For example, the 
 kidneys take from the blood the nitrogenous 
 products of waste, the liver the carbo-hydro- 
 gen products of the same. This question 
 has yet to be answered by physiologists. It 
 is well known to the physician, that if tartar- 
 emetic or ipecac be injected into the bowels 
 or into the blood, it will produce nausea 
 
82 BRIGHT'S DISEASE. 
 
 and vomiting as if taken into the stomach. 
 If urea be introduced into the stomach or 
 injected into the circulation, it makes its ap- 
 pearance in the kidneys for elimination ; if 
 Cantharides, turpentine, and the various 
 balsams be taken into the system, they are 
 likewise eliminated by the kidneys. The 
 nervo-vital energy possesses the power of 
 establishing affinities or sympathies in the 
 excretory organs by w T hich they attract 
 certain substances from the blood that, if 
 retained, would be injurious to the system. 
 It is upon this basis that homoeopathists 
 prove their remedies. For example, in 
 desiring to know the properties of a remedy, 
 they give it to several persons in health 
 unknown to each other; when symptoms 
 are produced alike in all these provers, it 
 shows that the remedy has a special affinity 
 for certain parts of the system, and the 
 symptoms that are produced in these parts 
 are their guide in selecting the remedy when 
 a diseased condition exists presenting simi- 
 lar symptoms. Certain organs evince affini- 
 ties for certain remedies, and these affinities 
 are produced by the vital energy of the soul, 
 correlating with the organic nerve-energy. 
 
CHAPTER IV. 
 
 Abnormal Condition of the Kidneys in 
 Bright's Disease. 
 
 The structural changes that take place in 
 Bright's Disease during its progress have 
 been classified under different heads. Rein- 
 hardt and Frerichs believe the disease results 
 from inflammation of the kidneys, and have 
 divided it into three stages ; I. The inflam- 
 matory stage; 2. The exudation, in which 
 is observed a fatty degeneration of the epi- 
 thelium lining of the tubes and the glome- 
 rules ; 3. Abnormal growth of the connect- 
 ing tissues, terminating in atrophy. The 
 German and French pathologists insist 
 upon the unity of the disease ; the English 
 pathologists, on the contrary, deny the 
 unity, maintaining that the disease com- 
 prises several distinct forms. They base 
 their opinion on the cause, the symptoms, 
 and the pathological changes that occur. 
 Dr. Johnson, in his work on disease of 
 the kidneys, published in 1852, and his 
 lectures on the same subject, published in 
 
 83 
 
84 BRIGHT'S DISEASE. 
 
 1873, divides this disease into acute and 
 chronic forms. The former represents the 
 inflammatory stage, and the latter the 
 pathological changes that occur during the 
 progress of the disease. The first change, 
 involving the epithelium lining of the urin- 
 iferous tubes and the glomerules, constitutes 
 the red granular kidney. When the paren- 
 chymatous structure (the body of the kidney) 
 becomes involved, we have the second 
 stage of the disease; this constitutes the 
 large, white kidney. When the organized 
 tissues become absorbed, and atrophy takes 
 place, it comprises the third stage, and is 
 called the lardaceous or waxy kidney. 
 Roberts, Dickson, Stewart, and others have 
 somewhat modified the division of Johnson, 
 without materially differing with him, or 
 throwing light upon the subject. We 
 therefore deem it unnecessary further to 
 refer to these writers, as it will only confuse 
 the reader, instead of enlightening him. 
 There is no doubt but that Bright's Disease 
 assumes two distinct forms, acute and 
 chronic, as is the case with a large majority 
 of diseases, providing the former is allowed 
 to pursue its course. In the acute form 
 
ACUTE AND CHRONIC. 85 
 
 there is a higher grade of inflammation, 
 which is due to an active impairment of the 
 nervo-vital energy of the vaso-motor nerves, 
 causing a relaxation of capillary blood-ves- 
 sels of the kidneys, and consequently an 
 accumulation or superabundance of blood 
 in the parts involved. Nature endeavors to 
 overcome the nervous shock, and if she 
 succeeds the acute stage subsides. If she 
 only partially succeeds, inflammation be- 
 comes somewhat lessened, and the disease 
 gradually passes into what is called the 
 chronic form. We cannot conceive why 
 there should be a conflict of opinion between 
 the English and Continental pathologists, 
 for Bright's Disease, when it becomes mani- 
 fested in the kidneys, and is allowed to con- 
 tinue, causes various pathological changes. 
 In the acute form it is more functional than 
 organic, but if permitted to continue, the 
 changes described by the English physi- 
 cians occur. Yet it is one and the same 
 disease. Although Bright's Disease is 
 always accompanied by inflammation, the 
 mere fact of inflammation does not consti- 
 tute Bright's Disease. Inflammation is an 
 ennervation of the vaso-motor nerves, per- 
 
86 BRIGHT'S DISEASE. 
 
 mitting a relaxation of the capillaries, and 
 causing an increased flow of blood to the 
 parts, consequently an increased redness 
 and oxidation, therefore an increase of tem- 
 perature. All this may occur without the 
 elimination of albumen, which is the charac- 
 teristic feature of Bright's Disease. To pro- 
 duce this inveterate complaint something 
 more than inflammation must exist. In 
 Brighfs Disease we have not only an enner- 
 vation of the vaso-motor nerves (the cause of 
 inflammation), but an ennervation of the 
 nerves of the solar plexus, causing a change 
 in the secretion of the cellular structure of the 
 uriniferous tubes, and a change in the nutri- 
 tion of the entire kidney, and this constitutes 
 Brighfs Disease. We therefore are of the 
 opinion that Bright's Disease assumes two 
 distinct forms, acute and chronic, which we 
 shall treat of separately. 
 
 i. The Acute. — This form is not near so 
 common as the chronic ; it occasionally 
 follows the acute stages of scarlet fever, 
 small-pox and diphtheria. In the first 
 instance, it sets in about the end of the 
 second week, and in cases where the erup- 
 tion is not well defined, and is aggravated 
 
PATHOLOGICAL CHANGES. 87 
 
 by exposure to cold and dampness. In 
 small-pox, it occurs during the disquama- 
 tion period, and in cases where the system 
 has received a severe shock from the poison. 
 In diphtheria, it makes its appearance in 
 cases where the system is very much re- 
 duced. The acute form occasionally occurs 
 during pregnancy, but generally terminates 
 with it. The vegetable and mineral poisons, 
 and the too free use of alcoholic drinks, 
 bring about a similar condition of the kid- 
 neys. The pathological changes observed 
 in the acute form are principally confined to 
 the cortical portion of the kidneys. The 
 Malpighian bodies present a dark-red ap- 
 pearance ; their epithelium covering is more 
 or less detached, and the capillary walls 
 thickened. The epithelium lining of the 
 tubes is more prominent and elevated, 
 giving evidence of overgrowth. The tubes 
 become choked with exuded epithelium 
 cells mixed with more or less blood. The 
 cells lining the tubes may be natural, but 
 opaque, and disintegrate rapidly and are 
 easily detached from the basementmembrane. 
 There is an exudation in the form of 
 transparent cylinders of various sizes in 
 
88 BRIGHT'S DISEASE. 
 
 the tubes that have shed their epithelium. 
 These abnormal changes seriously impair 
 the function of the kidneys, and, if not 
 arrested, death ensues from blood-poisoning. 
 In the acute form, the disease may not be so 
 active as to produce death ; the inflammation 
 gradually subsides, and merges into the 
 chronic form, or the disease may be 
 arrested, the inflammation entirely removed, 
 the nervous energy re-established and the 
 patient restored to health. 
 
 2. The Chronic. — This form may result 
 from the acute, or the disease may assume 
 the chronic form from the start, and develop 
 so gradually and imperceptibly as to be un- 
 noticed by the patient, his friends or his 
 physician. Most writers describe three 
 stages of this form of B right's Disease based 
 upon pathological changes observed after 
 death : 
 
 1 . That of inflammation with commencing 
 exudation, frequently called tubal nephritis 
 on account of the uriniferous tubes being 
 the principal seat of diseased action. 
 
 2. Granular Degeneration, in which exu- 
 dation has taken place, which subsequently 
 extends to the intertubular matrix. 
 
INFLAMMATORY STAGE. 89 
 
 3. The Waxy or Lardaceous Form. — In 
 this stage of the disease, the kidneys undergo 
 degeneration and atrophy. 
 
 These three forms or types of disease 
 may be summed up as follows: 1. The 
 smooth white kidney. 2. The granular 
 mottled kidney. 3. The waxy or amyloid 
 kidney. 
 
 1. The Inflammatory or First Form 
 of Chronic Bright's Disease.— The morbid 
 changes are very similar to those observed 
 in the acute form ; the inflammation is less 
 active. If we examine the cortical sub- 
 stance with a magnifying glass, we find scat- 
 tered through it haemorrhagic spots, the 
 result of congestion or engorgement of the 
 glomerules, giving it a mottled or granular 
 appearance. We also find an increase in 
 the number and size of the oil-globules of 
 the epithelium lining of the tubules. As 
 the disease advances the tubes become dis- 
 tended and filled with cast-off epithelium 
 oil-globules and blood corpuscles, all mat- 
 ted together, completely blocking a portion 
 of the tubes, while others are comparatively 
 free, their epithelium presenting a healthy 
 appearance. In the ' more advanced stage 
 
90 BRIGHT'S DISEASE. 
 
 of the disease the epithelium lining of the 
 cortical portion of the tubes is destroyed, 
 and fibrous casts of these tubes are thrown 
 off The medullary portion and the glome- 
 rules are not seriously involved. 
 
 The hyperplastic process takes place in 
 the basement membrane, and not in the 
 epithelium cells as is generally supposed, 
 and is dependent upon cnncrvation of nervo- 
 vital energy, causing a rapid development of 
 nerve cells and nuclei and an increase of oil- 
 globules. Here growth over-reaches the 
 boundary of harmony, by which it is guided 
 in health. If this condition continues the 
 epithelium is imperfectly formed, the walls 
 of the tubes lined with the granular mass 
 instead of cells. Fortunately for the patient 
 this condition does not exist in all the 
 tubules. If it did the excretory function of 
 the kidney would be suspended and the 
 nitrogenized products of waste retained in 
 the blood, and the patient die of uraemia or 
 blood poison. Occasionally in this stage of 
 the disease, the structural change is not 
 confined to the tubules, but extends to the 
 fibrous structure in which fatty degenera- 
 tion is found, causing an enlargement of the 
 
GRANULAR STAGE. 91 
 
 organs to double their natural size, giving 
 the kidneys a yellowish-white appearance — 
 hence the name : the smooth white kidney. 
 
 This form of Bright's Disease is generally 
 traced to some exciting cause, as cold, con- 
 sumption, pregnancy, scarlet fever, etc. In 
 one hundred and six cases examined by 
 Dickson, the average age was about twenty- 
 eight years. 
 
 The urine is scanty, pale and cloudy, 
 specific gravity normal ; if permitted to 
 stand, it deposits a sediment consisting of 
 tube-casts, epithelial, fatty matter, granular 
 and cretaceous substance. Dropsy is almost 
 always attendant on this form ; the skin is 
 white, flesh soft and flabby, face pale and 
 puffy. There is seldom heart trouble ac- 
 companying this type of the disease, but it 
 is a frequent attendant in the granular form. 
 There is very frequently, however, secondary 
 inflammation as pneumonia, peritonitis, etc. 
 It runs its course, however, in a much 
 shorter time than the granular form, usually 
 in from six to nine months. Occasionally, 
 however, it may be prolonged for several 
 years. 
 
 2. The Granular or Second Form of 
 
92 BRIGHT'S DISEASE. 
 
 Chronic Bright's Disease. — The kidneys 
 are diminished in size and weight. The 
 surface is very unlike that in the form just 
 described, being uneven or rough, owing to 
 the number of small elevations, varying in 
 size from a pin's head to a pea. The capsule 
 adheres closely to the adjacent surface, and 
 presents a granular appearance. The texture 
 of the kidney is tough and unyielding. If 
 the cortical portion be examined, it will be 
 found very much contracted, forming a thin 
 rim around the pyramids, not more than 
 one-sixth of an inch in thickness. If we 
 examine it with a microscope, we find it has 
 undergone a marked morbid change. The 
 Malpighian corpuscles are diminished to 
 half their size, and closely crowded together 
 by a fibrous and granular investment. Por- 
 tions of the tubes are denuded of their 
 epithelium, and so contracted as to present 
 mere tubular threads. Others are blocked 
 up with broken-down epithelium and oil- 
 granules. What is remarkable, normal or 
 healthy tubes are found side by side with 
 those that have become almost obliterated. 
 It is the generally accepted opinion that the 
 morbid process commences in the epithelium 
 
GRANULAR STAGE. 93 
 
 cells lining the tubes. Dickson and Stewart 
 maintain that it occurs in the inter-tubular 
 space, which they consider an overgrowth 
 or hypertrophy of the fibrous tissues which 
 compresses the Malpighian corpuscles. In 
 this way, they account for the contraction 
 of the cortical portion of the kidney. As 
 the disease progresses, the pyramids become 
 involved, cysts are frequently met with, 
 which vary in size from a pin's head to a 
 pea. They are evidently formed by the 
 obstruction and distention of the urinife- 
 rous tubes, for they are found lined with 
 an epithelium and filled with an exudation 
 that is not urinous, but albuminous. These 
 cysts are generally found in the cortical 
 substance, and occasionally in the cones. 
 
 This type of the disease makes its appear- 
 ance insidiously, without any definite or ex- 
 citing cause. It advances slowly, and may 
 exist for months, and even years, and the 
 sufferer be unconscious of it until it is dis- 
 covered by his physician. The urine is 
 generally at first copious and of low specific 
 gravity. As the . disease advances the 
 quantity gradually diminishes, the albumi- 
 nous deposit is slight and occasionally ab- 
 
94 BRIGHT'S DISEASE. 
 
 sent. In the majority of cases there are to 
 be found in the urine epithelium and gran- 
 ular casts, which are eliminated from the 
 uriniferous tubes. In many, perhaps half 
 of the cases, there is no dropsical effusion ; 
 when it is present, it is generally limited to 
 the ankles and under the eyes. Such per- 
 sons are generally pale and anaemic, with 
 countenance pinched, and the skin presents 
 a sallow appearance. Hypertrophy, or en- 
 largement of the heart, is a very frequent 
 accompaniment, and from half to two-thirds 
 of the cases are afflicted with this form of 
 cardiac difficulty. There is a general 
 cachectic condition of system, showing con- 
 clusively an impaired nutrition. Out of two 
 hundred and fifty cases examined by Dick- 
 son, the average age was about fifty years. 
 
 3. Third Form of Chronic Bright's 
 Disease. — Waxy or Lardaceous Kid- 
 ney. — In this form of the disease the kid- 
 ney is usually enlarged. The cortical por- 
 tion presents a whitish or light yellow color. 
 If a section be examined with a microscope, 
 it has a waxy appearance, and is confined 
 almost exclusively to the muscular coats of 
 the blood vessels. The Malpighian cor- 
 
THE THIRD STAGE. 95 
 
 puscles are the first to become affected with 
 this waxy deposit. As the disease advances, 
 the arteries and capillaries of the entire kid- 
 ney become involved ; the epithelium of the 
 tubules is contracted and infiltrated with 
 fat corpuscles ; the liver and spleen are 
 usually found to contain the same fatty de- 
 posit. The true nature and source of the 
 waxy material has not been definitely de- 
 termined. Dickson supposed it to be a 
 species of fibrin, containing less alkali, and 
 a larger proportion of earthy salts. Vir- 
 chow believed that it belonged to the same 
 class of substances as salt and cellulose, on 
 account of its yielding a violet color when 
 combined with sulphuric acid and iodine. 
 It is evidently of a protean character, for it 
 contains the same amount of nitrogen as 
 the protean compounds. Lilje the granular 
 form of this disease, it makes its appear- 
 ance in cachectic persons, and comes on in- 
 sidiously. In the commencement the urine 
 is generally copious, and as it advances it 
 diminishes in quantity, while its specific 
 gravity increases. The albumen at first is 
 but slight, but becomes quite profuse as the 
 disease advances. The urine is pale, and 
 
96 BRIGHT'S DISEASE. 
 
 contains epithelium cells and fat corpuscles. 
 This form of the disease maybe diagnosed by 
 the abundance of albumen in the urine, the 
 profuse dropsical effusions, and the general 
 wasting of the system. It is not unfre- 
 quently complicated with syphilis or phthisis, 
 and, when the system has been reduced, by 
 constant suppuration. 
 
CHAPTER V. 
 
 What is Bright's Disease? Its Cura- 
 bility. 
 
 Bright's Disease is generally understood 
 to be an inflammation of the kidneys, either 
 acute or chronic, and characterized by albu- 
 minous deposits in the urine. We do not 
 deny the correctness of this so far as 
 the kidneys are concerned, but it declares 
 only the effect of a cause which must be 
 sought for, ascertained and controlled before 
 we can expect to place it amongst the cura- 
 ble diseases. Therefore to designate it as 
 inflammation of the kidneys with albumi- 
 nous deposits in the urine, does not give a 
 correct idea of its character, magnitude or 
 cause. 
 
 The main object of this work is to call 
 the attention of those suffering with this 
 troublesome complaint to some new facts as 
 to the cause, and afford them hope that, if 
 the disease be treated in time, it will not be 
 found incurable, as it is supposed to be by 
 physicians generally. It is almost a univer- 
 9 97 
 
98 BRIGHT'S DISEASE. 
 
 sal opinion, in the profession, that the dis- 
 ease, in its chronic form, is incurable, and 
 they are often too free and decided in giving 
 an unfavorable prognosis as soon as they 
 ascertain that a person has Bright's Disease. 
 This belief also prevails with the community, 
 and when confirmed by the physician the 
 patient gives up all hope of recovery, which 
 naturally depresses fhe vital energies, and 
 thus hastens the progress of the disease. 
 On the contrary, we do not regard it as 
 right and proper for the physician to buoy 
 up the patient with false hopes. We have 
 known instances in the last two years where 
 persons afflicted with Bright's Disease could 
 have been cured, or, if not cured, life pro- 
 longed, where the attending physician 
 insisted (when the patient contemplated 
 change of treatment) that there was not the 
 slightest hope for a cure. They asserting 
 that the best authorities in the profession 
 had pronounced the disease incurable — that 
 settled it. Tvro of the cases to which we 
 . have reference, are in their graves, while 
 those who were quite as severely afflicted, 
 if not more so, are enjoying comparatively 
 good health. • 
 
THE VITAL FORCE. 99 
 
 Disease being an abnormal life action, it 
 will be necessary, in order to understand it 
 properly, to have a knowledge of normal 
 life, the former being merely a deviation 
 from the latter. As life cannot be manifested 
 without motion there must be, in the 
 universe, a life energy. Many advanced 
 scientific thinkers maintain that life results 
 from molecular change. 
 
 This cannot be correct, for the organized 
 principle or vitalized energy controls the 
 physical force. We find when there is an 
 expenditure of nerve-force, disintegration of 
 the tissues ensues, corresponding to the 
 amount of vital energy manifested. If the 
 brain be overactive or the nervous system 
 overtaxed, or the function of an organ in- 
 creased, we find an increase in the disinte- 
 grated products eliminated from the system, 
 which shows that more waste has taken 
 place than when there is less activity. As 
 no function in the physical economy can be 
 performed without life existing, and, as life 
 cannot exist without vital energy, the cause 
 of disintegration, which is death, must be 
 the relaxing of the vital or life force. The 
 moment the vital force ceases its control 
 
100 BRIGHT'S DISEASE. 
 
 over the molecular or physical force, disin- 
 tegration ensues. To replace this waste 
 with living structure, the vital energy again 
 controls the physical forces ; if this did not 
 take place, and disintegration continued, the 
 system would soon be reduced to a condi- 
 tion where life could not be sustained. In 
 some parts of the organism, the waste is 
 more rapid than in others ; this occurs 
 where the vital energy is the most active. 
 Waste and growth vary with age; from 
 infancy to manhood or womanhood, the 
 the growth exceeds the waste ; from the 
 latter to the decline of life, they are nearly 
 balanced. In old age, the waste exceeds 
 the growth and at death growth ceases ; the 
 vital energy is suspended and no longer 
 controls the molecular or physical forces, 
 and disintegration of the body follows as 
 a natural result. In proof of the vital 
 energy being the master-workman: when- 
 ever it is overtaxed, we find the physical 
 organism giving way, the waste being 
 greater than the growth, the system soon 
 becomes dilapidated and the vital force is 
 gradually compelled to yield to the mole- 
 cular, which, if continued, must terminate 
 
THE VITAL FORCE. 101 
 
 in death. We have another proof of the 
 control of the vital force over the physical 
 in the unfecundated egg. If it be submitted 
 to a normal temperature, it will decompose ; 
 an egg fecundated, submitted to the same 
 temperature, will develop into a chick. 
 Many more facts could be given to verify 
 our assertion, that the life-action taking 
 place in the physical organism does not 
 result from chemical or physical change, as 
 Herbert Spencer and others would have us 
 believe. His definition of life-action is : "A 
 definite combination of heterogeneous 
 changes, both simultaneous and successive 
 in correspondence with external co-ex- 
 istences and sequences." Or, as G. H. 
 Lewis defines it, " A series of definite and 
 successive changes, both of structure and 
 composition, which takes place within an 
 individual without destroying its identity." 
 Neither attempts to define what it is that 
 causes these changes and sustains the 
 organism through physical life. 
 
 The reader will naturally inquire what 
 
 constitutes the vital force. We have already 
 
 discussed what it is in Chapter II., when 
 
 speaking of the function of the nervous sys- 
 
 9* 
 
102 BRIGHT' S DISEASE. 
 
 tern. It is the energy of the soul, which 
 unfolds from the cell-germ with the physi- 
 cal body, and is the force imparted by the 
 parents. It is therefore purely a subjective 
 force, and correlates with the organic nerve 
 forces, the two combined constituting the 
 nervo-vital forces. Growth is an integra- 
 tion, a building up of organic structure, in 
 which the vital and nerve forces are corre- 
 lated. In disintegration, or decay, the cor- 
 relation is suspended, and the physical 
 forces are permitted to have control, re- 
 ducing the tissues to their normal chemical 
 condition. Death is nothing more nor less 
 than a general disintegration. Nutrition is 
 a nervo-vital action, in which the subjective 
 or vital force, and the objective or nerve 
 force, both participate, being correlated. 
 When nutrition is impaired, as it is in 
 Bright's Disease, the correlation of the two 
 forces is disturbed. When a person is in vig- 
 orous health, and has what is usually termed 
 a robust constitution, the vital energy is 
 active ; in impaired health and in old age it 
 is inactive. We will therefore perceive that 
 instead of life being the result of chemical 
 or molecular changes, it is the reverse — it is 
 
A MALIGNANT GROWTH. 103 
 
 death, not life. The scientists have placed 
 the cart before the horse ; they have Nature 
 turned up side down, or round about. 
 
 If the nervous system undergoes the 
 slightest structural change from impaired 
 nutrition, or other causes, the correlation 
 of the nerve and vital forces is impaired to 
 the extent of the pathological change. 
 Every intelligent physician knows that 
 serious functional disturbance may take 
 place in the nervous system, as in convul- 
 sions, lock-jaw, etc., causing death, without 
 leaving the slightest structural change be- 
 hind. In such cases there is no derange- 
 ment of the nervous structure ; it is merely 
 an imperfect correlation of the forces. Such 
 violent functional derangements may be 
 compared to an organic cyclone or tempest, 
 which is difficult to overcome, owing to the 
 impossibility of re-establishing the correla- 
 tion of the forces. 
 
 About three years ago, the author con- 
 cluded, after a strong appeal being made to 
 save a life, to test his views of life-action in 
 the treatment of a malignant growth. The 
 unfortunate individual was a gentleman in 
 his seventy-third year. He had a large 
 
104 BRIGHT'S DISEASE. 
 
 fungus haematodes on his arm, just below 
 the shoulder; an eminent surgeon was 
 called in to examine the case with a view of 
 removing it, or amputating the arm in order 
 to get rid of the stench, if nothing more. 
 He declined, stating that an operation could 
 not be borne, and even if it could, it would 
 not prolong life a great while, for his sys- 
 tem was " rotton with cancer!' I undertook 
 the case with no great expectation of bene- 
 fiting him. In about three weeks after 
 commencing treatment, a shrinkage was 
 observed with the lessening of the dis- 
 charge and odor. A few days after, the outer 
 border of the tumor appeared to deaden and 
 drop off, leaving a healthy surface. This con- 
 tinued until the whole abnormal growth 
 had disappeared, and the parts healed. The 
 time occupied in the treatment was about 
 four months. There were no local applica- 
 tions used, the remedies were given with 
 a view to improve nutrition, and to change 
 the growth from an abnormol to a nor- 
 mal one. It is over two years since this case 
 was treated and there has been no return. 
 A similar plan of treatment must be adopted 
 in Bright's Disease, in which there are two 
 
ESSENTIALS. 105 
 
 conditions that must be met : one is the 
 congestion of the kidneys and the other a 
 structural change taking place in the cortical 
 portion of the same. In the former, the 
 capillaries surrounding the uriniferous 
 tubes are relaxed, owing to an ennervation 
 of the vaso-motor energy permitting too 
 much blood to be eliminated from the capil- 
 laries for the formation of a normal base- 
 ment membrane, causing an increased cell 
 development, and a corresponding disinte- 
 gration. It is well known among physiolo- 
 gists that the activity of epithelium cells 
 depends upon the amount of blood supplied 
 and the nervo-vital energy imparted to it. 
 If the capillaries of the salivary glands be 
 dilated, the increased flow of blood to the 
 glands causes a rapid increase in the secre- 
 tions, and a more rapid disintegration of 
 the cells ; on the contrary, if the blood-sup- 
 ply be diminished, the secretions are 
 lessened and become more fluid or watery. 
 If the nerves leading to these glands be 
 divided, the secretions become vitiated or are 
 entirely suspended, proving that nervo-vital 
 energy and blood-supply, are the essentials 
 for cell-action. The same will apply to all 
 
106 BRIGHT'S DISEASE. 
 
 secretory or excretory cell structures. If 
 the secretions are increased, there must be 
 a corresponding increase of cell formation, 
 and a corresponding cell disintegration. 
 
 Fig. 9. 
 Morbid products observed in the urine in Bright's Disease : a, 
 epithelium casts ; b, 5, transparent or hyaline casts ; c, d, fatty- 
 matter. (From Reynolds.) 
 
 This condition we find in the kidneys in 
 Bright's Disease. In its early stage, there 
 is a congestion of the kidneys from a 
 relaxation of the capillaries, permitting an 
 increased elimination of blood serum to the 
 
GROWTH AND DISINTEGRATION. 107 
 
 basement membrane, an increase of epi- 
 thelium cell formation, and an increased 
 secretion, providing the nervo-vital energy 
 is not too greatly ennervated. As activity 
 
 Fig. io. 
 
 Morbid products eliminated by the kidneys in Bright's Disease, 
 and observed i 1 the urine by the aid of the microscope. a y a, fatty 
 casts ; b, b granular casts ; d, d, free fatty molecules. (From 
 Reynolds). 
 
 of growth must be attended by a corres- 
 ponding disintegration, we find a large 
 amount of epithelium cells in the urine. 
 As the nervo-vital energy becomes more 
 exhausted, we find the cell-lining of the 
 
108 
 
 BRIGHT'S DISEASE. 
 
 tubes thrown off before they have accom- 
 plished their office, which is the elimination 
 of the solid contents of the urine. These 
 are called epithelium tube-casts [Figs. 9, 
 
 Fig. 11. 
 
 a, a, transparent casts observed in the urine in a case of chronic 
 Bright's Disease of eight months' duration; b, &, the same form of 
 casts from chronic Bright's Disease (large white kidney) ; c, the 
 same form of casts from a case of chronic Bright's Disease (con- 
 tracted kidney, with fatty degeneration). (After Reynolds.) 
 
 10 and 11]. As the exhaustion continues, 
 the cells are not formed, there not being 
 sufficient vital energy imparted to the 
 substance of the basement membrane to 
 
TUBE-CASTS. 109 
 
 develop the growth of cells beyond the 
 granular layer [Fig. 5]. 
 
 If a still greater exhaustion of nervo-vital 
 energy occurs, we find but slight traces of 
 vital action in the basement membrane; no 
 more than is sufficient to organize the 
 membrane into a semi-gelatinous condition, 
 as we find in the amoeba, or lowest organ- 
 isms. In this stage of the disease we find 
 in some of the tubes no trace of the granu- 
 lar or epithelium layers, nothing more than 
 a structureless membrane, which is thrown 
 off and called transparent tube-casts [Fig. 
 11]. The formation and elimination of 
 the three forms of tube-casts have never 
 been explained. The views we have ad- 
 vanced of vital energy and life action in- 
 dicate the progress of Bright's Disease as 
 it is manifested in the kidneys. With the 
 aid of the microscope'we may, by observing 
 these different tube-casts in the urine, ascer- 
 tain the progress of the disease by the too 
 rapid disintegration, which is not checked 
 because the vital energy has become weak- 
 ened. While these changes in the cor- 
 tical substances are going on, the medullary 
 
 10 
 
110 BRIGHT'S DISEASE. 
 
 portion of the kidneys becomes involved, 
 owing to the same ennervation. 
 
 In order to impress upon the mind of the 
 reader, we assert that no life action can take 
 place in the material organism without the 
 correlation of the soul or vital force and 
 molecular nerve force, the action of the two 
 constituting physical life. Simple hyper- 
 trophy is a derangement of the correlation 
 of the nervo-vital energy, with an increase 
 of the vital over the molecular energy, 
 inducing change of form, but not of type. 
 Simple atrophy is a derangement of the cor- 
 relation of the same energies, with a decrease 
 of the vital, also causing change of form, but 
 not of type. When the change of type and 
 form both occur we have abnormal growth, 
 the malignancy of which will depend upon 
 the extent of the impaired correlation. In 
 the most malignant form of cancer, such as 
 the fungus haematodes, the correlation of the 
 forces is almost suspended, and the vitality 
 of the part is at a very low ebb. The same 
 law will apply to all structural changes, or 
 functional derangements occurring in the 
 living organism. 
 
 It would afford us pleasure to dwell 
 
DISAPPROBATION. Ill 
 
 more fully on this important and interesting 
 subject of vital energy, but space will not 
 permit, and we shall therefore refer the 
 reader, if interested in the subject of life, 
 and how it may be prolonged, to a subse- 
 quent work we hope soon to have ready 
 for the press. 
 
 Before closing the chapter we wish briefly 
 to express our disapprobation of the stress 
 laid on pathological changes observed after 
 death, as a chief guide to diagnosis of dis- 
 eased action. It is remarkable with what 
 care physicians, in examining bodies after 
 death, note the color, form, consistency, 
 etc., of the diseased parts, without searching 
 for the cause of their abnormal changes. 
 The heart may be as large as that of an ox, 
 or as small as that of a dog ; the brain 
 as hard as a Dutch cheese, or as soft as 
 lard ; the liver as white as the face of a 
 Caucasian, or as dark as the face of a Ma- 
 lay; the kidneys may be enormously en- 
 larged, or shrunken to half their natural 
 size. Yet what does all this prove ? Simply 
 a change of structure from a cause unper- 
 ceived by the pathologists. Mr. Lee quotes 
 in his " Mineral Springs of England," the 
 
112 BRIGHT'S DISEASE. 
 
 following from the pen of Dr. Kreysig, 
 which is pertinent to the question we are 
 now discussing. He says : " Physicians 
 are in the habit of regarding the solid parts 
 as the primary agents of life, to which the 
 fluids are subordinate; but, on the con- 
 trary, the blood and the nervous system are 
 the primitive and essential instruments of all 
 the organic functions, while the solid parts 
 occupy the inferior grades, and are of but 
 secondary importance in disease. The ele- 
 ments of general and internal disease, or 
 the morbid predispositions which form the 
 most important objects of treatment, may, 
 then, all be reduced to a vitiated state of the 
 blood and the lymph, or to *the derange- 
 ment of the nervous system/' We would 
 remark that the " blood" and the " lymph" 
 could not become vitiated excepting through 
 ennervation of energy of the organic nerv- 
 ous system. Professor George B. Wood* 
 taking exception to the generally received 
 opinion as to the cause of albuminuria, states : 
 " The most probable explanation appears to 
 be that there is some failure in the vigor 
 of the assimilating process, dependent on 
 
 ♦Treatise on the Practice of Medicine, Sec. Ed., Vol. II, p. 508. 
 
SEMMOLA'S VIEWS. 113 
 
 the same cause which has predisposed the 
 [kidneys, to the morbid deposition going on 
 within them, and that the two effects, in- 
 stead of having any mutual dependence, are 
 merely co-existing results of the same con- 
 cealed agency." Dr. Henry Hartshorn, in 
 the American edition of Reynold's System 
 of Medicine, Vol. Ill, page 662,* states that 
 " Semmola insists that true Bright's Dis- 
 ease is always connected with; or consists 
 in a general nutritive disorder, to which the 
 affection of the kidneys is secondary. This 
 disorder begins, according to his statement, 
 in an arrest of cutaneous respiration. Next 
 follows imperfect digestion, and transforma- 
 tion of albuminoid food ; and the presence 
 of an excess of albumen, with deficient 
 formation of urea in the blood. Hence re- 
 sults renal irritation and inflammation, albu- 
 minuria, and diminished excretion of urea. 
 At a later period, when the kidneys have 
 undergone considerable morbid alteration, 
 the secreting structure fails to eliminate the 
 urea which is formed. Then, and not be- 
 fore, will uraemia take place. Semmola con- 
 
 * Gazette Medicate de Paris, 1875, quoted in British Medical 
 Journal, September 27th, 1879. 
 
 IO* 
 
114 BRIGHT'S DISEASE. 
 
 siders that pathologists have generally too 
 much neglected the dyscrasic character of 
 Bright's Disease, and its special dependence 
 (being thus set apart by him from albumi- 
 nuria, or other causes, e.g. alcoholism, gout, 
 etc.), upon the gradual action of cold upon 
 the skin." The source of Bright's Disease, 
 from observation and treatment, is not to be 
 found in the pathological changes observed 
 in the kidneys after death. They are merely 
 the effect of a cause that must be sought 
 for and ascertained before it can be success- 
 fully treated. The disease may exist for 
 a long time before any morbid change is ob- 
 served in the functions and structure of the 
 kidneys. Of this we shall speak more fully 
 in the chapter on the cause of Bright's 
 Disease. 
 
 As this work is not written for the pro- 
 fession, but for those predisposed to and suf- 
 fering from Bright's Disease, we have not 
 considered it advisable to give treatment, 
 as any educated physician, who understands 
 the functions of the organic nervous system, 
 will be able to select suitable remedies to 
 correct ennervation, overcome renal conges- 
 tion, and improve nutrition. This is all 
 
HEALTH RE-ESTABLISHED. 115 
 
 that is required of the physician. Nature 
 will accomplish the rest, providing too 
 serious structural changes have not oc- 
 curred in the kidneys, and too serious com- 
 plications have not taken place in other or- 
 gans. Physicians familiar with Bright's 
 Disease must have observed that in many 
 cases of the chronic form, before the disease 
 has become established, serious local troubles 
 have occurred in other parts of the system, 
 This proves that the ennervation is not con- 
 fined to the kidneys, but is very generally 
 diffused, and by correcting it nutrition is 
 re-established, structural changes gradually 
 disappear, abnormal functions are restored 
 to their natural condition, and health is 
 re-established. The nervo-vital energy has 
 great recuperative powers, and all that is re- 
 quired is assistance from a skilful and edu- 
 cated physician. 
 
 y 
 
CHAPTER VI. 
 
 Symptoms of Bright's Disease. 
 
 We have already stated that Bright's 
 Disease is usually divided into acute and 
 chronic, and the latter is again divided into 
 three or more forms, corresponding to the 
 pathological changes observed. 
 
 i. The Acute Form. — This form of. the 
 disease makes its appearance suddenly, and 
 generally attended with chilliness, fever, 
 headache, nausea and vomiting. There is 
 frequently a dull, aching-pain in the region 
 of the kidneys, with soreness on pressure, 
 and skin dry. Dropsy usually appears very 
 early and generally commences in the face, 
 causing a fullness under the eyes, with a 
 stupid or heavy expression of countenance. 
 It soon extends to the upper extremities, 
 making its first appearance in the hands. 
 Soon the chest becomes involved, and, 
 finally, the lower extremities. In males, the 
 scrotum is a favorable location for the 
 dropsy to make its appearance ; sometimes 
 it becomes almost as large as a child's head. 
 
 116 
 
GENERAL SYMPTOMS 117 
 
 In a few cases, the swelling commences in 
 the feet and extends upwards, becoming 
 general. If the patient should be kept in a 
 recumbent position, the back is the part 
 most swollen ; as the dropsical effusion in- 
 creases, there is a corresponding lessening 
 of the quantity of urine secreted. In some 
 aggravated cases, it is completely sup- 
 pressed, which is a very alarming symptom. 
 In the early stage of the disease, the urine, 
 instead of having the natural amber color, 
 presents a smoky appearance, which is 
 owing to the coloring matter of the blood. 
 The urine has an acid reaction, and a spe- 
 cific gravity ranging from 1025 to 1030, 
 and has been known to reach as high as 
 1060. If the disease passes into the 
 chronic form, the specific gravity lessens 
 and may fall as low as 10 10. If the urine 
 be permitted to stand for a short time, a 
 flocculent, brownish sediment forms. If 
 it be examined with a microscope, it will be 
 found to consist of blood corpuscles, epi- 
 thelial cells, free nuclei, coagulated fibrin 
 and tube-casts, which consist of three forms 
 corresponding to the three layers of the 
 walls of the uriniferous tubes. They are 
 
 y 
 
118 BRIGHT'S DISEASE. . 
 
 described as the epithelial, the granular and 
 the hyaline or transparent tube-casts [see 
 Figs. 9, 10 and n]. The first, called the 
 epithelium, constitutes the secreting portion 
 of the tubes ; the second, the granular, lies 
 immediately below the former, and the third 
 is the hyaline or transparent, formed of 
 lymph eliminated from the capillaries, of a 
 semi-fluid character, and forming what is 
 called the basement membrane of the tubes. 
 When these layers are all thrown off, the 
 tubes are obliterated or completely des- 
 troyed, leaving the capillary network, which 
 is highly congested. Fortunately, it is 
 only a part of the uriniferous tubes that is 
 destroyed (excepting in extreme cases), 
 the others being comparatively healthy, or 
 merely stripped of a portion of their epi- 
 thelium. There are also found in the sedi- 
 ment oil-globules, which are a normal 
 product of the kidneys, found distributed 
 among the tubules. 
 
 If the urine be boiled it will be found to 
 contain a large amount of albumen which is 
 the characteristic feature of Bright's Dis- 
 ease. The normal constituents of the urine 
 such as urea, uric acid, etc., are very much 
 
FAVORABLE SYMPTOMS. 119 
 
 reduced in quantity, owing to the structural 
 change taking place in the uriniferous tubes, 
 they being the natural channel through 
 which they are eliminated. The drain of 
 albumen from the blood impoverishes it and 
 the retention of the nitrogenous products 
 poisons it. The two combined depress the 
 vital energies of the system, causing an 
 imperfect assimilation which is shown in 
 the diminution of blood corpuscles. The 
 reduction of the red corpuscles of the blood 
 and the anaemia caused by it, are attributed 
 to the amount of blood eliminated by the 
 kidneys. This is so small that it will not 
 account for it; another cause must be 
 sought for. We attribute it to imperfect 
 assimilation caused by an ennervation of the 
 organic nervous system. 
 
 The acute form of the disease may con- 
 tinue for a few days or many months, and 
 the patient apparently recover, or it may pass 
 into the chronic form and continue for many 
 years. If it should have a favorable termi- 
 nation, the quantity of urine will be in- 
 creased, the specific gravity diminished, the 
 albumen will gradually subside and the 
 tube-casts disappear in the urine. The skin 
 
120 BRIGHT'S DISEASE. 
 
 becomes moist and the dropsical effusion ab- 
 sorbed. Convalescence is generally slow, 
 and requires from two to six months for the 
 kidneys to assume their natural functions 
 and the system to recover from the shock. 
 Recovery is not complete until the urine is 
 entirely free from albumen, and the dropsical 
 symptoms have entirely disappeared. If 
 albumen continues in the urine w T ith tube- 
 casts, it is evidence of structural change go- 
 ing on in the cortical substance and of the 
 disease assuming a chronic form. Some- 
 times in the acute form the albumen almost 
 disappears from the urine, which may be 
 merely a lull in the disease to be followed 
 by an exacerbation more severe than the 
 previous attack, A relapse of this kind may 
 generally be attributed to cold and damp- 
 ness, diseased kidneys being very suscepti- 
 ble to both. 
 
 The unfavorable symptoms of the acute 
 form are an increase of the albumen, a dimi- 
 nution of the quantity of urine passed and 
 a change in the color of the urine, which 
 becomes darker, owing to the elimination of 
 blood. 
 
 This form of Bright's Disease is occa- 
 
COMPLICATIONS. 121 
 
 "sionally accompanied with complications 
 which are considered by some writers as 
 local symptoms. For example, oedema of 
 the lungs they regard as a general dropsy. 
 Inflammation of the serous membrane very 
 frequently takes place. Pleurisy is the most 
 common ; pericorditis is less frequent, and 
 peritonitis very seldom occurs. Pneumo- 
 nia is- occasionally a complication but not 
 so frequent as bronchitis. Hypertrophy 
 of the heart rarely occurs in the acute, but 
 is a frequent complication in the chronic, 
 form of the disease. 
 
 cute Bright's Disease is not confined to 
 any particular age ; a large majority of cases 
 occur during childhood and youth, and as a 
 general rule the person attacked has previ- 
 ously enjoyed good health. 
 
 II. Chronic Form. — The general symp- 
 toms of Chronic Bright's Disease cannot be 
 more clearly given than in the following'ex- 
 extract from Reynolds' " System of Medi- 
 cine," American Edition by Dr. Hartshorn : 
 
 " In the gre^t majority of instances 
 
 chronic Bright's Disease begins slowly and 
 
 imperceptibly. The attention of the patient 
 
 is awakened, some months, or it may be 
 
 ii 
 
122 BRIGHT'S DISEASE. 
 
 years, after it has existed, by the gradual 
 failure of his strength and his increasing 
 pallor or sallowuess, with a disinclination to 
 exertion ; or his suspicions are aroused by a 
 little puffiness under the eyes, a slight swell- 
 ing of the ankles at night, unusually fre- 
 quent calls to void urine, or shortness of 
 breath. In other cases these premonitions 
 pass unheeded or are altogether wanting. 
 The disease proceeds silently, amid appar- 
 ent health, and then suddenly declares itself 
 by a fit of convulsions, rapid coma, amau- 
 rosis, pulmonary oedema, or a violent inflam- 
 mation ; or it may lie concealed for an un- 
 determined period, and then reveal itself, 
 after exposure to cold or a fit of intoxica- 
 tion in the guise of an acute attack, with 
 rapid general anasarca, scanty, sanguineous 
 urine ; or it may be a continuation or se- 
 quela of acute Bright's Disease ; or lastly, it 
 may creep on stealthily in the wake of some 
 pre-existing chronic disorder, phthisis, caries, 
 necrosis, constitutional syphilis, gout, chronic 
 alcoholism, or exhausting suppuration. 
 
 " The principal symptoms of the disease 
 are : albuminous urine with deposits of tube- 
 casts and renal epithelium, especially at 
 
GENERAL SYMPTOMS. 123 
 
 night; dropsical effusions into the subcuta- 
 neous cellular tissue, serous cavities, or pul- 
 monary substance; dryness of the skin, de- 
 rangements of digestion ; progressive hy- 
 dremia ; uraemic phenomena (headache, am- 
 blyopia, convulsions, coma, vomiting, and 
 diarrhoea) ; hypertrophy of the left ventricle ; 
 secondary inflammation of the parenchyma- 
 tous organs and serous membranes. 
 
 " Few cases present the whole of these 
 symptoms : many present only two or three 
 of them. The alterations in the composi- 
 tion of the urine are the most invariable, 
 and also the earliest and most distinct symp- 
 toms ; next follow in the order of constancy, 
 the deterioration of the blood, the dropsical 
 symptoms, and, lastly, the uraemic and in- 
 flammatory incidents. 
 
 " The disease usually pursues an inter- 
 rupted course, being subject to occasional 
 exacerbations, with intervals of quiescence. 
 The exacerbations are generally by expo- 
 sure to cold, or some imprudence in diet 
 or regimen ; sometimes no cause can be as- 
 signed for their occurrence. They are 
 marked by pyrexia, and often simulate an 
 attack of acute Bright's Disease. The inter- 
 
124 BRIGHT'S DISEASE. 
 
 vals of quiescence may be some weeks or 
 months, or a few years ; the remission of 
 the symptoms is commonly only partial, 
 the main features of the disease persisting, 
 though in a modified degree. Sometimes, 
 however, the remission is almost complete, 
 and little except the albuminous state of the 
 urine remains to attest the existence of 
 renal mischief; and even this may, in ex- 
 ceptional cases, be absent, and the nature 
 of the case be first revealed at the autopsy. 
 After each exacerbation it is commonly 
 pretty evident that the disease has pro- 
 gressed a step, and probably an additional 
 portion of the kidney, hitherto spared or 
 only slightly affected, has been disabled. 
 The kidneys are at length so seriously dis- 
 organized, and their depurative functions so 
 far abrogated, that life becomes impossible. 
 " The immediate cause of death is vari- 
 able. Sometimes the sufferer passes quietly 
 away, exhausted by anaemic, burdensome 
 anasarca, and defective digestion. About 
 one-third of the subjects of chronic Bright's 
 Disease perish by uraemic poisoning, either 
 in the form of coma and convulsions or 
 irrepressible diarrhoea and vomiting. A 
 
SPECIAL SYMPTOMS. 125 
 
 considerable number die from the intensity 
 or dangerous situation of the dropsical 
 effusion, as when the glottis or lungs are 
 invaded ; or death results from the hydro- 
 thorax, or from gangrenous erysipelas set 
 up in the tense oedematous integuments of 
 the legs, thighs, or genitals. About one-fifth 
 die by secondary pneumonia, pericarditis, 
 or double pleurisy. The remainder are cut 
 off by remote complications, as apoplexy, 
 cirrhosis, phthisis, intestinal ulcerations, etc. 
 
 " The duration of the disease can only be 
 approximately ascertained from the difficulty 
 of assigning the exact date of invasion. 
 Enough is, however, known to show that it 
 varies within very wide limits. The usual 
 period is from two to three years ; but cases 
 may end in six months, or be protracted for 
 four or five years. Exceptional instances 
 have been recorded in which patients have 
 survived ten years, and even fifteen and 
 twenty years." 
 
 Special Symptoms and Complications: 
 Urine, — "The quantity of albumen is 
 variable. The urine may become absolutely 
 solid on boiling, or it may contain only the 
 minutest traces of albumen, even in con- 
 ii* 
 
126 BRIGHT' S DISEASE. 
 
 firmed and fatally-tending cases. The 
 amount of albumen lost in twenty-four 
 hours varies commonly from forty-five to 
 three hundred grains ; Dr. Parks observed 
 in one instance, five hundred and forty-five 
 grains. During digestion, the quantity is 
 larger (it may be double) than during fast- 
 ing; it rises and falis irregularly in the 
 course of the disease, sometimes diminish- 
 ing to a trace, and anon increasing to an 
 intense impregnation. 
 
 " The urine is generally pale and slightly 
 turbid, depositing, on standing, amorphous 
 whitish sediment of renal epithelium and 
 tube-casts. It sometimes contains blood, 
 occasionally in quantity, but generally in 
 
 microscopic proportions When 
 
 the case is complicated with phthisis, or 
 regurgitant heart disease, the urine may be 
 high-colored and turbid from lithates. 
 
 "The quantity of urine voided per day 
 varies with the type of the disease, and the 
 presence or absence of pyrexia, sweating, 
 vomiting, or diarrhoea. The specific grav- 
 ity is low when the urine is copious (1006 
 to 1010); but when scanty, the specific 
 gravity may rise to 1030, or even to 1040. 
 
SPECIAL SYMPTOMS. 127 
 
 The urine is nearly always acid, and not 
 unfrequently deposits uric acid and oxalate 
 of lime. Occasionally I have noted alka- 
 line from a fixed alkali, and on two occasions 
 ammoniacal on emission. The renal deriva- 
 tives are markedly scantier in chronic than 
 in acute Bright's Disease; they are not un- 
 usually entirely absent for limited periods. 
 They are, however, sometimes discoverable 
 when the urine has temporarily ceased to 
 be albuminous. The epithelium cells may 
 be simply withered ; more rarely they are 
 totally disintegrated into an amorphous 
 granular debris; in other cases they contain 
 specks of oil, or they may even be wholly 
 converted into an agglomeration of oily 
 particles, so as to appear identical with the 
 granular corpuscle, or inflammation globule. 
 If the casts are similarly speckled with fat, 
 and free oily dots are scattered over the 
 field, it indicates a fatal disorganization of 
 the organs — either large, fatty kidneys, or 
 contracted granular ones. Considerable 
 diversity in the character of the casts, dis- 
 charged by the same individual, even during 
 the same day, may be met with, arising 
 from a different condition of the several 
 
128 BRIGHT'S DISEASE. 
 
 parts of the gland; conclusions as to the 
 probable state of the kidney can only be 
 drawn from the. prevailing character of the 
 deposit, and not from one or two individual 
 casts or cells. The casts most commonly 
 seen in chronic B right's Disease are ' small ' 
 and ' large* hyaline forms and 'granular* 
 opaque ones, any of which may have a few 
 wasted epithelium cells strewed over them. 
 Perfect 'epithelial' casts are rare; blood- 
 casts are also rare, in chronic cases, unless 
 there be concomitant tricuspid regurgitation. 
 Large hyaline casts result from exudation 
 having been thrown into tubuli denuded of 
 their epithelium. [The more rational con- 
 clusion is that the hyaline cast is the base- 
 ment membrane that has not advanced to 
 the granular state, and that the granular 
 cast is the basement membrane that has not 
 advanced to the epithelium state. S. P.] 
 The longer the exudation is retained within 
 the tubuli, the darker and more granular 
 the casts, and vice versa) casts speedily dis- 
 charged are commonly hyaline. Some- 
 times casts are darkened by the coloring 
 matter of the blood, and the opaque granu- 
 lar ones are sometimes composed of crushed 
 
CHANGES IN THE BLOOD. 129 
 
 epithelial debris, moulded in the form of 
 tubuli. [Are not the opaque granular casts 
 the granular base with imperfectly formed 
 epithelial cells? S. P.] 
 
 "The normal solids of the urine are all 
 diminished in chronic Bright's Disease. 
 The urea is, as a rule, markedly reduced, 
 the daily quantity averaging only about one 
 hundred grains ; Frerichs has observed it as 
 low as fifteen grains. A case is mentioned 
 by Mosler, however, in which six hundred 
 and forty grains were voided in one day! 
 There is no correspondence, direct or in- 
 verse, between the urea-excretion and the 
 discharge of albumen." 
 
 Blood. — " The changes in the blood are 
 the complement of those in the urine; it 
 becomes more watery and poorer in albu- 
 men and red corpuscles, while the urea, uric 
 acid, extractive matter, and pale corpuscles 
 are relatively increased. This alteration 
 in the composition of the blood is deeply 
 concerned in the production of the more 
 prominent features of the disease — the an- 
 aemia, dropsical effusions, uraemic phe- 
 nomena, and secondary inflammations. 
 
 " Dropsy is much oftener absent in the 
 
130 BRIGHT'S DISEASE. 
 
 chronic than in the acute form. It is much 
 more constant with the smooth large than 
 with the granular contracted kidney, of 
 which probably one-third or one-fourth of 
 the cases run their entire course without 
 dropsy. The effusion begins quite as often 
 in the feet and legs as in the face, and is 
 apt to change its seat capriciously; some- 
 times it is excessive and general, but usu- 
 ally slight and partial. When the heart 
 or liver is diseased, ascites and oedema of 
 the legs become unduly prominent. The 
 effusion may disappear totally for months, 
 and then return ; more frequently after the 
 subsidence of the general dropsy, oedema 
 lingers obstinately in one or more places, 
 over the flat of the tibiae, about the ankles, 
 beneath the eyelids, or about the genitals. 
 The presence or absence of dropsy gen- 
 erally, but by no means always, corresponds 
 with the abundance or scantiness of the 
 urine, but it has no relation to the amount 
 of albumen. 
 
 " The skin is usually obstinately dry ; 
 perspiration is quite exceptional. . . . 
 . > Profuse sweating does, however, some- 
 times takes place spontaneously, and may 
 
COMPLICATIONS. 131 
 
 even continue for weeks. . ... The 
 integuments in some cases are excessively- 
 pale and glossy, more commonly sallow and 
 rough. There is little or no tenderness in 
 the renal region in the chronic cases, and 
 the frequency of micturation is mostly- 
 observed at night. Some degree of bron- 
 chitis is almost an invariable coincident in 
 both acute and chronic Bright's Disease. 
 
 " Complication and Connection with 
 Other Diseases. — The digestive organs 
 are nearly always disturbed ; at first, there 
 is anorexia [loss of appetite] and nausea, 
 and, later, frequent or even uncontrollable 
 diarrhoea and vomiting are not unusual. . 
 . . Secondary inflammation of the lungs, 
 endocardium, pericardium, peritoneum, or 
 integuments, may break out at any period 
 in the course of Bright's Disease, and the 
 tendency to these constitutes one of the 
 principal dangers of the complaint. 
 
 " Bright's Disease and Phthisis. — This 
 complication is of frequent occurrence. In 
 the great majority of cases the pulmonary- 
 disease is far advanced before renal symp- 
 toms appear, the long-continued discharge 
 of pus from the lungs at length giving rise 
 
132 BRIGHT'S DISEASE. 
 
 to waxy changes in the kidneys, followed 
 by albuminuria and dropsical effusions. 
 But sometimes the renal disease precedes 
 the pulmonary, and the changes found in 
 the kidneys after death are not invariably 
 of the waxy type." 
 
 Hypertrophy of the heart, especially of 
 the left ventricle, is a very frequent attend- 
 ant in chronic Bright's Disease, which is 
 supposed by Traube to be caused by in- 
 creased tension in the arterial system, pro- 
 ducing an increased resistance, which the 
 left ventricle has to overcome. 
 
 Uraemia. — The prominent symptoms are 
 drowsiness, impaired vision, and dullness of 
 hearing, nausea, vomiting, diarrhoea, and 
 finally coma or convulsions. The cause 
 is the retention in the blood of disintegrated 
 products, owing to a derangement of the 
 functions of the kidneys. The headache is 
 generally in the forehead, vertex, and back 
 of the head, and deep in the orbits. There 
 is also a sense of weight and compression, 
 attended with dimness of vision, which 
 comes and goes, or may be attended with 
 temporary loss of sight. The coma comes 
 on insidiously, and may not be noticed by 
 
COMPRESSIBLE PULSE. 133 
 
 those in attendance, supposing it to be 
 nothing more than drowsiness, until convul- 
 sions occur. Not unfrequently the coma 
 and convulsions occur simultaneously. As 
 a rule the urine is very greatly diminished, 
 or completely suspended before the coma 
 and convulsions take place. These may be 
 regarded as alarming symptoms, and if not 
 relieved promptly, will terminate fatally 
 within a short time. 
 
 It will not be amiss to mention an obscure 
 symptom of Bright's Disease, which, if not 
 interesting to the general reader, may be of 
 service to physicians, if they have not already 
 observed it. It is a feebleness of the heart, 
 causing a weak and compressible pulse, 
 which becomes more so as the disease ad- 
 vances. The heart's energy is derived from 
 the medulla oblongata, through the pneumo- 
 gastric nerve. The medulla is the co- 
 ordinating centre of the spinal system, and 
 the solar ganglion the co-ordinating centre 
 of the organic or sympathetic nervous sys- 
 tem. The pneumo-gastric nerve distributes 
 the energy that controls respiration, and the 
 action of the heart and its branches anas- 
 tomose with the solar plexus. It is from 
 12 
 
134 BRIGHT'S DISEASE. 
 
 this plexus that the uriniferous tubes (the 
 seat of Bright's Disease in the kidneys) re- 
 ceive their nerves. It is well known among 
 physiologists that an injury to the medulla, 
 or to the pneumo-gastric, brings about albu- 
 minous deposits in the kidneys, as well as 
 diabetes. This shows the intimate relation 
 existing between the two great co-ordinating 
 centres, the medulla oblongata, situated at 
 the upper portion of the spinal cord, and the 
 semi-lunar ganglion, the centre of the or- 
 ganic nervous system. 
 
 I would also remark that one of the first 
 evidences of improvement in Bright's Dis- 
 ease is in the action of the heart giving 
 more tone to the pulse, thus enabling it to 
 offer more resistance to pressure. The en- 
 feebled condition of the pulse is not con- 
 fined to Bright's Disease, but is frequently 
 found in various forms of chronic diseases. 
 In all cases exhibiting this form of pulse, 
 with symptoms favoring Bright's Disease, I 
 have invariably examined the urine, and very 
 frequently found traces of the disease. It 
 therefore gives us a cue in many cases 
 which might otherwise be overlooked until 
 the disease becomes permanently established. 
 
CHAPTER VII. 
 
 Causes of Bright's Disease. 
 
 /The causes of disease may be classified 
 as primary and secondary, the latter recog- 
 nized as the exciting cause. The primary 
 is an ennervation of the organic nervous 
 system, the secondary is the one that brings 
 out, or makes manifest, the primary cause. 
 As Bright's Disease assumes two distinct 
 forms, acute and chronic, and the exciting 
 causes being different in the former from 
 what they are in the latter, we will, in order 
 to make the subject clear, speak of them 
 separately. 
 
 i. Secondary, or Exciting Causes of 
 the Acute Form. — A large percentage of 
 the acute cases of Bright's Disease are 
 sequelae of scarlet fever, and other infectious 
 diseases, such as diphtheria, small-pox and 
 measles ; skin diseases and extensive burns 
 are also recognized as secondary causes. 
 Some of the mineral and vegetable poisons 
 are known to have been the means of de- 
 veloping Bright's Disease by causing 
 
 135 
 
136 BRIGHT'S DISEASE. 
 
 inflammation of the kidneys. Among the 
 mineral poisons are arsenic, lead, nitrate of 
 silver, and mercury, and among the vege- 
 table, turpentine, phosphorus, oils of worm- 
 wood and mustard. Cantharides, which we 
 find in some medical works classified with 
 the vegetable poisons, is not a vegetable, 
 but an animal product ; it is a very active, 
 exciting cause, inflaming the kidneys, 
 and, in fact, the whole urinary tract. Alco- 
 holism is a very frequent cause of both the 
 acute and chronic forms. What is called 
 "moderate drinking" is potentially an excit- 
 ing cause not only of Bright's Disease, but of 
 gout, heart troubles and liver complaint. Phy- 
 sicians are almost universally of the opin- 
 ion that the drinking of alcohol in any form, 
 save at meals, should not be indulged in. 
 Pregnancy is also a cause, and generally 
 occurs in lymphatic persons of a weak or 
 feeble constitution with soft and flabby 
 muscular fibre. Protracted and low forms 
 of fever are occasionally a cause of the 
 acute form of this disease. 
 
 2. Secondary or Exciting Causes of 
 the Chronic Form. — The causes of this 
 form of Bright's Disease are more nupier- 
 
SECONDARY CAUSES. 137 
 
 ous and more insidious in their action than 
 those of the acute. Perhaps the most fre- 
 quent causes are fast living, mental strain, 
 anxiety and moderate drinking. Over- 
 indulgence in eating or drinking impairs the 
 functions of the digestive organs, particu- 
 larly the stomach and liver. The kidneys 
 are overtaxed in the elimination of the 
 superabundance of nitrogenous products of 
 the food not required for the growth of 
 tissue, and which must be eliminated. The 
 liver being overtaxed from the excessive 
 carbon and hydrogen of the alcoholic 
 drinks, becomes weakened in its functions, 
 and the kidneys are called upon to elimi- 
 nate not only the superabundance of food, 
 but also the carbon and hydrogen that the 
 liver cannot. In this way the kidneys 
 become involved. 
 
 We can thus account for the frequency of 
 the disease in apparently strong and vigo- 
 rous constitutions, in persons of fine phy- 
 sique. Among statesmen and the mercan- 
 tile community the active cause is mental 
 strain, sleeplessness, and want of proper 
 rest — in many cases accompanied with 
 anxiety. During the war it became more 
 12* 
 
138 BRIGHT'S DISEASE. 
 
 frequent and after the collapse of business 
 in 1875 it increased. Alcoholism without 
 anxiety or mental strain is sufficient to 
 cause Bright's Disease ; a confirmed tippler 
 whose system is saturated with alcohol is 
 very apt to have fatty degeneration of the 
 liver and kidneys. Frequent exposure to 
 cold and dampness by checking perspiration 
 often causes congestion of the kidneys and 
 leads to a morbid condition which is subse- 
 quently increased by chilling of the body. 
 Sexual excesses, consumption, syphilis, 
 deep-seated abscesses, long-continued sup- 
 purating surfaces, are also active causes. 
 Malaria of late years is assigned as a cause 
 by depressing the vital energy of the or- 
 ganic nervous system. Heredity is another 
 cause, which in one or more subsequent 
 generations, owing to the present frequency 
 of the disease, will very likely show itself 
 actively. The weakness of parents is im- 
 parted to their offspring, and will crop out 
 at some period of life ; if not in their 
 children, it will in their grandchildren. 
 It is not an unfrequent occurrence 
 for a hereditary disease to skip a genera- 
 tion ; when it does, it generally reappears 
 
COMPARATIVE AGES. 139 
 
 in an aggravated form. Simon found that 
 confining animals in a dark room for a long 
 time produced a fatty degeneration of the 
 kidneys. Was it the absence of light, or 
 the fear and despondency induced by the 
 confinement ? Light is evidently a vital 
 tonic, but it is questionable whether the 
 simple confinement in darkness would be 
 sufficient to produce structural change in 
 the kidneys. 
 
 Chronic Bright's Disease more frequently 
 occurs between the ages of 30 and 60 years, 
 seldom in children. Dr. Dickinson ob- 
 served the disease in a lad of five years and 
 Dr. Gee in the case of a boy of two and a 
 half years. 
 
 The following table of 61 cases of the 
 lardaceous form has been compiled by Dr. 
 Dickinson: 
 
 Age,o-io, No. of Cases, 3 
 
 11-20, 11 
 
 21-30, 21 
 
 31-40, 10 
 
 41-50, 10 
 
 51-60, 3 
 
 61-70, 3 
 
 Over 70, o 
 
140 BRIGHT'S DISEASE. 
 
 Dr. Dickinson also gives a table of 308 
 cases of the granular kidney, 
 
 1 was between 11 and 20 
 
 24 were 21 and 30 
 
 50 31 and 40 
 
 93 41 and 50 
 
 76 51 and 60 
 
 47 61 and 70 
 
 17 Over 70 
 
 3. The Primary Cause. — Whatever cause 
 will produce inflammation of the kidneys, 
 when there is an ennervation of the organic 
 nervous system may produce Brighfs Disease. 
 The same may be applied to the lungs in 
 consumption. The ennervation is the pre- 
 disposing or primary cause and an active or 
 exciting cause makes it manifest. 
 
 A predisposing cause, whether it be 
 hereditary or acquired, may lie dormant in 
 the system for years, as we frequently find 
 in consumption, scrofula, Bright's Disease, 
 etc., and suddenly be made manifest by a 
 cold, or some other exciting cause. If 
 physicians, particularly those who make a 
 specialty of chronic diseases, were to seek 
 more earnestly for the cause, they would 
 find their efforts crowned with greater sue- 
 
SEEKING PRIMARY CAUSE. 141 
 
 cess than they now are. To be successful 
 in the treatment of diseases, the primary 
 cause must be sought for and removed be- 
 fore functional and structural changes, 
 which are only the effects, can be checked. 
 
CHAPTER VIII. 
 
 Advice to Those Suffering From 
 Bright's Disease. 
 
 In the acute form there is but little ad- 
 vice to give, as disease is ushered in so sud- 
 denly, and in many cases symptoms are so 
 urgent as to require at once the services of 
 a physician. His first efforts will be to re- 
 lieve the kidneys ; he will treat other symp- 
 toms as the case demands. In the chronic 
 form it is different. The disease manifests 
 itself insidiously, and progresses very 
 slowly. The kidneys are morbidly suscept- 
 ible to cold and dampness, from which they 
 must be protected ; hence warm clothing is 
 indispensable, and must be of such a char- 
 acter as to prevent the body from becoming 
 chilled, which checks perspiration. Flan- 
 nel should be worn the entire year. During 
 the winter months the garments should be 
 heavy, and consist principally of wool. Cot- 
 ton flannels are of very little use; they do 
 not prevent the elimination of caloric to any 
 great extent. During the summer months 
 
 142 
 
CLOTHING, DRINKS, etc. 143 
 
 lighter flannels should be worn, to be 
 changed for heavier when there is a marked 
 fall of temperature. Many patients forget, 
 or do not consider it important, to change 
 clothing to meet the changes of the weather, 
 particularly during the spring and fall 
 months. I have for years recommended 
 light raw-silk shirts worn under the flannel. 
 During the summer months they should 
 be worn without the flannel. In Con- 
 sumption and chronic Bright's Disease I 
 frequently recommend silk shirts, drawers 
 and socks, with the happiest results; the 
 feet should be well protected from damp- 
 ness by wearing double-soled shoes, with 
 gum cloth or hog's bladder between the 
 soles, to prevent the dampness from striking 
 through. If they are double-uppers the 
 hog's bladder may also be placed between 
 them. Gum shoes may be worn during 
 wet and muddy weather, but should be re- 
 moved immediately upon entering the 
 house. The least dampness of the feet will 
 often cause the kidneys to become suddenly 
 congested. 
 
 Alcoholic drinks should be avoided, 
 unless they are really necessary to assist in 
 
144 BRIGHT'S DISEASE. 
 
 supporting the system. In such cases, good 
 Holland gin or Jamaica rum may be taken 
 at meals. The mind should be free from 
 care and anxiety, and moderate exercise is 
 beneficial rather than otherwise, providing 
 there is sufficient rest for nature to recuper- 
 ate the brain. Cheerful spirits, a contented 
 mind, accompanied with a clear conscience, 
 and firm will, will do wonders in warding off 
 diseases and prolonging life. A proper 
 amount of sleep is very essential ; it enables 
 the brain to recover from the depression 
 which ennervates the vital energy of the 
 organic nervous system through the pneu- 
 mo-gastric nerve. All those who have ex- 
 perienced the loss of sleep know how it 
 depresses the system and how refreshing is 
 a good night's rest. The sleeping apart- 
 ment should be well ventilated by an open 
 fire-place, grate, or some one of the modern 
 means of ventilating bed-rooms. The 
 lowering or raising of a window is objec- 
 tionable for fear of a draught, particularly 
 if the room be small and the bed placed near 
 enough for the current of air to strike it. 
 
 The diet should be nutritious and of a 
 mixed character ; it is customary for physi- 
 
SUITABLE DIET. 145 
 
 cians to discourage the eating of much ani- 
 mal food, on account of increasing the nitro- 
 genous products of waste in the blood. 
 Animal food is essential for healthy nutri- 
 tion, but it may be advisable in the more 
 advanced stage of the disease, when there 
 is a suppression of the function of the kid- 
 neys, to dispense with it. But in the earlier 
 stages I would recommend a good nutri- 
 tious diet, consisting in ordinary propor- 
 tions of animal food. In Bright's Dis- 
 ease the trouble lies in the ennervation of 
 the organic nervous system. There is 
 deficient assimilation of all the products of 
 nutrition. Food is of no use unless it is 
 properly vitalized ; when taken into the 
 system, it is dead matter and must be vital- 
 ized before it can supply the wants of the 
 organism. This is accomplished during the 
 passage of the chyle through the mesenteric 
 glands and liver. If assimilation should be 
 imperfect, vitalization is deficient, and it 
 undergoes chemical change, the same as the 
 disintegrated products after life-action has 
 been expended, and is eliminated by the 
 kidneys and other excretory organs in the 
 same manner as products of waste. I there- 
 13 
 
146 BRIGHTS DISEASE. 
 
 fore approve of a mixed diet of a nutri- 
 tious character, providing the patient is 
 treated with a view to increase the vital 
 energy of the nervous system. As it is 
 increased, animal food may be given in 
 larger quantity once or twice a day, for 
 breakfast and dinner. A light supper, con- 
 sisting of bread and milk, oatmeal or 
 crushed wheat and milk ; this will keep the 
 bowels regular, aid digestion and not inter- 
 fere with sleep. I would also recommend, 
 if there is much debility, milk taken at 
 intervals of three or four hours, and, if the 
 system seems to require it, I would suggest 
 rum or gin punches taken two or three 
 times a day. Exercise in the open air, 
 either by walking or riding, is conducive to 
 health, and, therefore, should be taken ad- 
 vantage of whenever opportunity affords. 
 
 Bathing is advisable ; a tepid bath once 
 or twice a week, followed by a good rubbing 
 of the skin to increase its circulation, is very 
 desirable. It relieves the congestion of the 
 kidneys and increases the secretion of the 
 skin, and thus assists in the elimination of 
 urea and uric acid from tbe blood, which 
 the kidneys are enabled to do only to a 
 
BATHING, RUBBING, etc. 147 
 
 limited extent. I have been in the habit of 
 recommending to patients, in connection 
 with bathing, the rubbing of the skin with 
 a coarse crash towel or Turkish rubber, 
 saturated with a solution of rock-salt of 
 sufficient strength to bear an egg. When 
 saturated, it is to be hung up to dry ; the 
 body and limbs are to be rubbed with this 
 prepared towel once a day, morning or 
 evening. After it has been in use one week, 
 it is to be washed, dried and again saturated 
 and used in the same way. This rubbing 
 increases the circulation of the skin, and 
 wonderfully relieves the kidneys of their 
 congested condition. It accomplishes more, 
 it increases the action of the secreting 
 glands of the skin and eliminates the pro- 
 ducts of waste. 
 
 As regards treatment, I have but little to 
 say, as this work is not written for physicians, 
 and if the treatment were given, it could not 
 be made use of without consulting a phy- 
 sician. Therefore, my advice is, to avoid 
 quacks as a saint would the fallen angel, 
 and place yourself in the hands of a skil- 
 ful doctor. There is, however, one form of 
 treatment that I must condemn, for I have 
 
148 BRIGHT'S DISEASE. 
 
 frequently seen its injurious effects. I have 
 reference to the administration of iron in 
 enormous doses; "saturating the system" 
 with it in order to overcome anaemia. This is a 
 great mistake for several reasons. In the 
 first place, it will not cure anaemia so long 
 as the vital energy is so ennervated that it 
 cannot carry on a normal assimilation. 
 Anaemia results from an impaired vitaliza- 
 tion of the chyle in its passage through the 
 mesenteric glands, and therefore the white 
 corpuscles cannot progress or advance to 
 the red corpuscles or blood-discs. There is 
 nearly always sufficient of iron in the food 
 and drink we take into the system for the 
 purposes of the economy. The vital energy 
 of the nervous system has its own laboratory 
 in which it combines the organic and inor- 
 ganic constituents in sufficient quantities to 
 suit its purposes, and it is during this com- 
 bination that they are vitalized. If there 
 should be an excess of any one or more in- 
 gredients, it is rejected and eliminated, the 
 same as the disintegrated products are by 
 the excretory organs. There is another ob- 
 jection to giving iron in massive doses, it 
 deranges the stomach and irritates the urin- 
 
SHUN QUACKS. 149 
 
 ary organs, particularly the bladder. If it 
 is to be administered at all in Bright's Dis- 
 ease, which is questionable, it should be 
 given in very small doses, for an exceed- 
 ingly small quantity is required for assimi- 
 lation. It will thus be seen that instead of 
 being beneficial in large doses, it is highly 
 injurious. There is another form of treat- 
 ment which I must caution those suffering 
 from this disease to shun as they would 
 their bitterest enemy. I refer to the numer- 
 ous remedies, advertised by quacks, for the 
 cure of Bright's Disease. They are usually 
 powerful diuretics which act upon inflamed 
 and irritable kidneys, forcing their function, 
 which they are unable to perform owing to 
 impaired energy, and thus increasing the 
 difficulty. I am not surprised at those afflicted 
 with this disease seeking such a source for 
 relief, for the regular physician gives the 
 patient no encouragement, and he is like a 
 drowning person clinging to a straw. The 
 kidneys require gentle treatment and any 
 remedy administered that will force them 
 must be injurious. 
 
 Much more might be said on the subject 
 of which this chapter treats, but as our 
 13* 
 
150 BRIGHT'S DISEASE CURABLE. 
 
 space is limited we will conclude by advis- 
 ing the patient to avoid quacks and their 
 medicines and seek the advice of an intelli- 
 gent and skilful physician, and that this be 
 done before the disease is too far advanced. 
 Chronic Bright's Disease is curable, even 
 after the kidneys are seriously disorganized, 
 providing the inflammation is removed and 
 the energy of the organic nervous system 
 re-established. The master-workman — the 
 vital force, located in the system, calls for 
 help, and if proper assistance be rendered in 
 time, it will be enabled to restore the parts 
 to their normal condition and re-establish a 
 healthy function. 
 
ANNOUNCEMENT. 
 
 We desire to announce to the public that 
 within three or four months we expect to 
 have ready for the press, a work of about 
 four hundred and fifty pages, 8vo., entitled 
 " Life, its Nature, Source, Purpose and 
 Destiny, and the Method and Means to 
 Prolong Physical Life." 
 
 Scientists admit that life exists but they 
 have hitherto been unable to give its source, 
 and how it becomes manifested in organic 
 forms. We shall endeavor to trace life 
 from its source and declare the forces 
 and laws by which it is enabled to unfold 
 life-organisms and sustain them for a limited 
 period, and show what becomes of them when 
 physical life ceases. In doing so we shall 
 trace energy and law from their primary 
 source, and show how the life principle 
 
 151 
 

 152 ANNOUNCEMENT. 
 
 controls them in the unfoldment of organic 
 forms. 
 
 This subject has been our almost constant 
 study for over thirty years, and we expect 
 to present it in such a manner as to be un- 
 derstood by the ordinary reader. The 
 work will' be illustrated with plates and 
 diagrams which will aid the reader in un- 
 derstanding this interesting subject. When 
 it is ready for the press a prospectus will be 
 issued, giving an outline of the work and 
 a description of the illustrations. 
 
LIBRARY OF CONGRESS 
 
 021 062 532 A