A Classification of Bright's Disease.
No classification of the conditions involved in chronic Bright's disease can with our present knowledge of its pathology be perfectly satisfactory. In my last number I presented a comparison of the facts concerned in nephritis which was based on the most popular classification.
An effort is now being made in France to classify all conditions under two heads: the first, is where there is a large amount of albumen and a small quantity of water with high specific gravity, dropsy without increase of arterial tension. These cases are usually classed as parenchymatous nephritis. It is now claimed that the above conditions may be observed without structural involvement of the kidney.
The second group is nearly the opposite of this in many particulars. It is distinguished in this classification as always presenting a tendency to uremia. In this group there is an increased quantity of urine with a low specific gravity and consequently a low amount of solids, little or no albumen, and no dropsy, as long as these conditions are present. In the last stages, when anuria occurs, dropsy follows. Uremia to a greater or less extent may be present at any time.
This classification could be distinguished then as the dropsical type and the uremic type. The first could be said to run a short course, and the latter a long course.
There are to me, as many objections to this classification as there are to the other. It is simpler however and this is a point in its favor. Every clinician knows there are many cases which present symptoms pointing to both types-mixed cases which demand close scrutiny, for their correct diagnosis.