This is a peculiar state of the kidney, which has been called after Dr. Bright, the eminent physician who first noticed and des cribed it.

This affection of the kidney has been divided into two varieties in one of which there is a small red kidney, and in the other a large white kidney. During the last few years the term acute Bright's disease has been applied to another condition of the kidney. "It is a state of extreme sanguine congestion, next door to, or even constituting acute inflammation of the kidney; and it is apt to occur after exposure to cold and wet, or during the course or certain febrile disorders, and most particularly in scarlet fever. When death, under these circumstances, takes place early, as it may do, the kidney is found to be gorged with blood, which sometimes drips freely from it when it is cut open. The kidney is in general large, somewhat flabby, of a deep dark red, or sometimes of a bright red colour.

"The symptoms that have been observed in this state are fever, preceded often by shiverings; uneasiness or dull pain in the loins; nausea and vomiting; a very scanty secretion of urine, which is sometimes tinged with blood; occasionally complete suppression of urine. To these symptoms is presently added, in most cases, sudden and general dropsy. If the secretion of urine be entirely suspended, death soon ensues." "Death in this stage of the disease is comparatively rare. With proper treatment most persons recover completely. Many seem to recover, but bear about with them the germs or beginnings of more chronic and latent changes which constitute one form of Bright's kidney.

"Cupping over the loins, hot baths, sudorific medicines, purgatives, and large warm injections, are the proper treatment for this formidable but curable complaint."

The coarse anatomical character of the kidneys in the two more chronic forms of Bright's disease are in striking contrast to each other. They differ remarkably in size and in colour, and are known as the large white and the small red kidney. The average weight of the adult human kidney is between four and five ounces. In Bright's disease, some have been met with weighing twelve ounces, others weighing scarcely two.

The symptoms that accompany these two conditions of the kidney are also very different. In both the urine is more or less deeply, and more or less permanently, charged with albumen. That which belongs to the contracted granular kidney, is, as a rule, copious in quantity, and in the advanced stages pale, of very low specific gravity; and it contains, as the microscope shews us, granular casts thrown off from its secreting tubes. The amount of albumen which it carries is comparatively small, and in some cases it is temporarily free from albumen; and the disease is seldom attended with dropsy, except perhaps, to a slight extent, when the end draws near. On the other hand, the urine of the large white kidney is fuller of albumen, and scarcely ever free from it entirely; is apt to be scanty, has a higher specific gravity than the other, and usually contains clear, fibrinous, wax-like, and sometimes oily casts, with occasionally a little blood; while life is seldom or never destroyed without the occurring of general dropsy.

The urine in this form of the disease may retain for a while its transparency and its natural sherry colour, but in the advanced stages it becomes pale, and often more or less opalescent. It froths also more than usual. If you blow into it through a tube you raise bubbles like those which may be formed on soapy water, and the bubbles remain long unbroken. Such urine very seldom deposits gravel.

When the acute disease is abating, the urine has, even to the naked eye, an unnatural appearance. It is dark, dingy, obscurely turbid, like muddy beer; smoky is an epithet frequently applied to it. This hue depends upon the presence of a little of the colouring matter of the blood darkened by the acid properties of the urine.

Bright's disease, in its chronic forms, is apt to arise and to steal upon its victims insidiously; to be latent and unsuspected until something or other suggests an examination of the urine.

Whenever a patient has to rise two, three, or more times in the night to make water, he should have his urine tested for albumen, particularly if it is free from sediment. This frequency of micturition by night is a symptom in some other disorders; in enlargement of the prostate gland, for instance: But, enlargement of the prostate is seldom present except in the latter periods of life. When there is stone in the bladder, micturition is less frequent in the night than during the day.

The remedies for the chronic disease must be those previously mentioned for the acute, with proper attention to the general state of the health.