sive action. The best remedy for the diarrhoea, which so often proves troublesome, and sometimes dangerous in Bright's disease, is the Edinburgh lead and opium pill, in the dose of five or ten grains twice or even thrice a-day; to which may be added, in severe cases, a fatty suppository of muriate of morphia. Vomiting may be sometimes removed by bismuth, but more frequently by morphia, hydrocyanic acid, creasote, pyroxylic spirit (medicinal naphtha), chloroform, or little fragments of ice; and when these fail, a blister over the epigastrium has sometimes succeeded. It is not necessary for me to say anything of the treatment of other secondary diseases. In all cases stimulant liquors should be used with caution; but they are sometimes unavoidable when the exhaustion is great. The diet, in the acute form, must be low, light, and farinaceous; but in the chronic form a moderate allowance of nutritive easily digested food, with a moderate use of liquids, has always appeared to me the preferable diet, when the patient can take it.

Bright's disease was long considered a very deadly one; indeed as generally fatal, sooner or later. This denunciation is probably true of the stearotic form. But it is quite incorrect, if extended to the more frequent form of inflammatory desquamation. This will appear from the following selection of cases, which I have singled out from a much more extensive list, because I have had the rare advantage, in their instance, of observing the results, for a very considerable term of years, after the first apparent recovery.

Case 2, already narrated, may be here in the first place referred to as an excellent exemplification of the ordinary treatment and usual phenomena and progress in the most favourable of cases. But, as the patient was sent to Ireland under the Poor-law arrangements soon after recovery, I have lost sight of her.

Case 4 was similar to this, but more obstinate, although eventually and permanently cured. The patient was a lady of 27, who in the seventh month of her first pregnancy, was attacked early in October 1846, with considerable œdema of the limbs, hands, and face. At the full time she was delivered of a still-born child, without any accident. The oedema then disappeared, and seemingly also the albuminuria, which had been constant before delivery. But her health continued indifferent; she regained neither flesh, strength, nor looks; the albumen re-appeared from time to time in the urine; the features often became again puffy; and at last, in the end of January, a tendency to diarrhoea was superadded. I saw her first on the 10th of February 1847, along with my colleague, Dr Simpson. At this time, six weeks after delivery, she was puffy in the features, very leucophlegmatic, not oedematous, weak, exhausted, emaciated, and exciteable. The pulse was 80, and irritable; the tongue clean and bleached; the bowels no longer loose; the appetite and digestion tolerable. The urine did not exceed 30 ounces daily, it was of natural colour, 1016 in density, turbid when just passed, and moderately coagulable. She was ordered morphia and ipecacuan instead of Dover's powder, the warm-bath, croton friction over the loins, and a rather generous diet, including a little wine. These measures were followed by gentle perspiration every night; and in eight days she looked and felt stronger, had a firmer pulse and excellent appetite, and suffered from no uneasiness of any kind. The urine amounted to 36 ounces daily, had a density of 1014, was less coagulable, but continued turbid when passed. The acetate of ammonia was now substituted for the morphia and ipecacuan. From this time she improved progressively; nor did I again see her as a patient. The urine soon lost its turbidity and albuminous impregration. She spent the subsequent winter on the continent, along with her family, as a precautionary measure; and since returning, has passed two winters in Edinburgh without illness, having born a living child during that period without any accident, and continuing still in excellent health. There was no microscopic examination of the sediment in this case. But every other particular combines to prove it a case of chronic inflammatory desquamation, the consequence of a peculiar renal irritation, which, in this city at least, has been often recognised as a concomitant of advanced pregnancy and the

NEW SERIES.-NO. XVIII. JUNE 1851.

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puerperal state. It may fairly be assumed, after four years of perfect health, and a second pregnancy without accident, that the cure has been radical. The cause of the connection of this disease with pregnancy is obscure. Pressure of the gravid uterus on the kidneys has been thought by some an adequate explanation; but this I doubt. The occurrence of renal disease, in such circumstances, has been observed only in persons pregnant for the first time. The present is the only instance I have seen in which the patient did not present the physiognomy of the strumous diathesis. It is seldom that the operation of any adequate occasional cause can be discovered, though we cannot doubt that exposure to cold, injuries of the loins, &c., would act on the predisposed with some energy.

CASE 5.-The next case is one of acute dropsy, with general febrile symptoms, unconnected with pregnancy, and to all appearance radically cured. The patient was a tall, robust female-servant, of 38, somewhat intemperate for five years, but habitually healthy. On the morning of 9th December 1846, her face swelled; in the evening, having worked all day in a draught, the legs began to swell; in three days the swelling was general; and she then felt so unwell as to be obliged to take to bed. During the next two days she had frequent chilliness, constant headach, one attack of epistaxis, and twice a severe hysteric fit. On her admission into the Infirmary, on the 15th December, there was leucophlegmatia; elastic oedema of the face, trunk, arms, and limbs; uneasiness and tenderness in the loins and pit of the stomach; headach and drowsiness; a frequent, sharp pulse, white tongue, and hot skin; and scantiness of urine, which was of natural colour, not turbid, 1025 in density, and very strongly coagulable. The liver was not enlarged; the heart was free of any sign of disease; and there was only a trivial catarrhal affection. She was first freely bled from the arm, and then from the loins by cupping. The blood drawn from the arm was much cupped and buffy. Diuretics then acted briskly, the cedema at the same time quickly subsiding, and along with it every other symptom, including the proportion of albumen in the urine. Dover's powder was substituted for the diuretics as soon as the oedema disappeared. The features gradually became less leucophlegmatic, and at the sametime the albumen ceased to show itself in the urine. At the close of January she was so well and strong that she became night-nurse in the ward, and soon afterwards laundry-maid. On May 7th, when in this capacity, she was a powerful, muscular, healthy-looking woman, and the urine was copious, quite free of albumen, and 1015 in density. Next summer I encountered her in the shape of a domestic servant at the Royal Lunatic Asylum, still enjoying perfect health. Dr Skae ascertained for me that in February 1850, having left the service of the Asylum, she was "alive, well, lately married, and without any complaint, except housemaid's knee, and the occasional consequences of drinking;" and a few days ago, on 7th March 1851, four years complete after her convalescence, he also ascertained that she continued in robust health.

If diuretics are apt to prove injurious in Bright's disease, as many now imagine, this was surely the very sort of case to exhibit the effect. Nevertheless, their influence was in every way salutary; for with the removal of the oedema, every other symptom also subsided, and nothing occurred to interrupt recovery.

CASE 6.-A medical friend, of the age of 38, actively engaged in country practice, sustained a compound fracture of the tibia in 1842, and an attack of acute rheumatism next year. In July 1845 he was seized with hæmaturia, and even when there was no blood present, he always found the urine coagulable. At the same time his appetite failed, he steadily lost flesh and strength, and had a constant nameless feeling of ill health; but he had no pain or frequency of micturition, and no morning sickness. When he first consulted me, two months after this attack, he had a haggard, dingy hue of countenance, a feeble appetite, but sound digestion, an excitable pulse, a white tongue, and a scanty, rather turbid, brownish-red urine, 1021 in density, and moderately coagulable. The sediment showed degenerated epithelium cells; but at that time I was not sufficiently acquainted with Gluge's researches to rely now on the other microscopic observations I made. There had never been any oedema; the heart's action was natu

ral in all respects, except that it was rather frequent, and easily excited; the liver was not enlarged. He was of a consumptive family. I recommended repeated blisters over the loins, the warm bath, a rather generous diet without stimulant liquors, and a pill of lead and opium, or gallic acid. On the 1st of October he reported to me that he had derived no benefit from the blisters, or opium and lead; but that, on substituting gallic acid for the astringent, the redness of the urine had gradually disappeared, and its coagulability had diminished. On October 17th I saw him again, still not strong, but without his former haggard look, and decidedly regaining flesh. He had some pain across the loins, but no other uneasiness connected with the urinary organs, and there had been no return of hæmaturia; but the urine was still somewhat coagulable. Circumstances having rendered it convenient for him to winter at the Cape of Good Hope, I advised him to resort thither; and, at his own suggestion, the gallic acid was continued. He returned to this country in October 1846, and wrote to me thus:-"As soon as I got into warm weather, and out of the turmoil of professional business, I began to improve in health and strength, gathered flesh, got colour, and, ere arriving at the Cape, was stouter than I had been for years. After using the gallic acid for a few days at sea, I had no appearance of albuminuria, nor has there been any return of it since. I travelled about 1500 miles on horseback through the Cape colony, and had several long journeys, one of them to the extent of eighty-eight miles in one day, without suffering any ill consequences." He also had a little share in the first Caffre war. On returning to this country he resumed his practice in an extensive range of country; and he continues to the present time, March 1851 (six years after his illness), an active, vigorous, healthy, country practitioner.

Those who are inclined to maintain that there is no such thing as Bright's disease without dropsy, will of course deny that this case has been rightly placed here, and may insist that it was simple chronic nephritis. In reply, I can merely say, that I have repeatedly seen cases precisely similar in all respects, except that there was also some anasarca; and others precisely similar, and without anasarca, but fatal,-in which, after death, the kidneys presented the characteristic appearances of advanced Bright's disease. This case, and one or two others communicated to me by the subject of it from his practice, led me to entertain, in regard to gallic acid, hopes which have not since been realised, either in his observation or in mine, so often as we could have wished.

CASE 7-Another medical friend, about 38, physician in a large county town, but formerly in the Army Medical service, after suffering from dyspepsia for ten years subsequently to an attack of ague in the East Indies, became liable to morning sickness and vomiting, early in the summer of 1846; and in the end of August he was seized, after protracted professional fatigue and anxiety, with an indescribable uneasiness in the loins, like painful pressure, and with somewhat frequent micturition. Fourteen days later he came to Edinburgh, to consult the late Dr Davidson and myself. He had a dingy, unhealthy complexion, the fetid breath I had often remarked in advanced Bright's disease, no great loss of strength or flesh, a frequent pulse and doughy tongue, and palish, clear, rather abundant urine, 1010 to 1015 in density, and highly coagulable. He was much harassed with sickness and vomiting before breakfast, as well as after meals; but he never had observed any anasarca. Dr Davidson and I agreed that he had Bright's disease, and entertained serious apprehensions of the result. Blood was withdrawn by cupping from the loins, and a succession of blisters was also resorted to; but without success. Bitter tonics with alkalies were of no use; but bismuth and bicarbonate of potash decidedly relieved the stomach complaints. The treatment in other respects was confined to relaxation from business, a low general diet, and the warm bath. In three weeks I visited him at his residence, and found him with an improved complexion, but not so strong, and considerably reduced. He had still on awaking sickness, clammy throat, and often vomiting; acidity, sickness, and vomiting after breakfast; but no uneasiness after dinner, since making the experiment of dining almost entirely on meat

and bread. The pulse was natural, the tongue cleaner, and the skin soft and perspirable. The urine amounted to forty ounces daily, and was high-coloured, clear, 1018 in density, less coagulable, and passed neither with unusual frequency nor any longer during the night. I recommended a meat breakfast, weak brandy and water for drink, a warm plaster over the loins, tincture of cardamom or hydrocyanic acid on awaking, and country air and carriage exercise. The cardamom relieved the morning sickness. Gallic acid was tried as an astringent, but disordered the stomach. Afterwards he derived decided relief from vegetable tonics, with bicarbonate of potash, opiates at night, and occasionally the powder of mercury and chalk, with ipecacuan as an alterative, on account of the disordered state of the alvine excretions. Under this treatment the urine became of higher density, till at length it was often 1026, 1028, or even 1030; and the albumen also decreased, though very slowly, so that it did not entirely disappear for eighteen or twenty months. By that time he was quite well. He has often examined the urine since, and has never observed the albumen to re-appear. He is now an active, healthy, rather muscular man, constantly engaged in the duties of his profession; and he has never been threatened with a return of his former complaints.

This case, too, may be thought by some to have been simple chronic nephritis, and perhaps with more reason than in the former instance, as the urine did not present a turbid appearance when just passed, and thus no satisfactory evidence existed of epithelial degeneration in the uriniferous tubes. Still I think it extremely difficult, in the present state of our knowledge, to draw a distinction between such cases and the more undoubted Bright's disease; and I must protest against the arguments used by some, that such cases are not Bright's disease, because there is no dropsy, and because they get well.

CASE 8. In 1838 I was consulted in the case of a retired merchant in the country, who had been recently attacked with universal and extensive anasarca. He was a man of 63, totally blind, nearly deaf, very intemperate, cross-tempered, and consequently a great burden to his family. His surgeon in the country, who consulted me by letter, could not find any thing wrong with the heart, liver or lungs, but had not adverted to the kidneys as a possible seat of the pathological cause of the dropsy. Having requested the urine to be sent for examination, I found it of moderate density, rather pale, somewhat turbid, and pretty strongly coagulable. I directed digitalis, squill, and bitartrate of potash to be given, to excite diuresis. These remedies acted with speed and force; the anasarca quickly disappeared; his general health was soon quite restored; the urine acquired its healthy characters; and ere long no trace of his disease remained. For seven years he enjoyed excellent health, but confined himself, on account of his helplessness, almost entirely to bed. In the end of 1845, having in the mean time changed his residence to Edinburgh, he again became my patient on account of gangræna senilis of the right foot; and he died of this disease in about two months, without any return of anasarca, or of urinary symptoms of any sort. An examination of the body could not be obtained.

CASE 9.-In my treatise on "Granular Degeneration of the Kidneys," p. 281, I have related a very interesting case of Bright's disease, which I have been fortunately able to trace at intervals ever since. This was an intemperate harbourporter at Newhaven in this neighbourhood, who, while slowly recovering in 1836 from a dangerous attack of pleuropneumonia, for which he took calomel and opium to salivation, was seized with symptoms of the acute form of Bright's disease, including great edema, scantiness and very strong coagulability of the urine, and considerable drowsy stupor. Blood-letting and diuretics gradually removed every urgent symptom; and in a few months he recovered his strength so thoroughly by residing in the country, that he was able to resume his occupation at Newhaven. Here he lived a temperate life and enjoyed excellent health for two years; but the urine continued pretty steadily so low as 1013 in density, and strongly coagulable. So far the account in my treatise. On inquiring for him again in 1840, I was informed by his brother porters

that he had left Newhaven for the interior, where he had resumed his former habits of extreme intemperance, and had died of delirium tremens. But this report proved to be a great falsehood and libel. For in 1847 I encountered him in the Infirmary waiting-room, again afflicted with dropsy, and in quest of relief where he had formerly been cured. He then told me, that in 1838 he had left his previous occupation for that of a railway-labourer, at which he had worked without intermission, and in excellent health, except when twice laid up by severe accidents; that he had adhered steadily to his vow of sobriety, which he took before his own conscience on recovering in 1836; and that he had never suffered from oedema, or any of his old complaints, till five days before returning to his old hospital quarters. He was now a man of 53, extremely tall and erect, having been a Lifeguards-man when young. There was great elastic oedema of the limbs, and less of the arms and trunk, much leucophlegmatia, erythema on both calves from distension, with superficial ulceration, and no frequency of the pulse or other sign of re-action. The urine was natural in quantity and colour, passed frequently at night, 1018 in density, and strongly coagulable. Acetate of lead and opium, and frequent warm-baths, were ordered. Under this treatment the cedema had substantially disappeared in the course of four weeks, and the urine had become slightly coagulable; and in three weeks more he left the hospital in good health, but with the urine still somewhat albuminous. I again lost sight of him for three years, when he appeared last summer to consult me respecting his daughter, but in excellent health himself. He had been for some time gate-keeper on the Caledonian Railway, about forty miles from town, had an extremely respectable appearance, and the expression of a sober, well-conditioned man, nor had he ever suffered from any illness after leaving the hospital. He gave me an opportunity of examining the urine, which was natural in colour, wholly free of albumen, and without any urine-tube-casts, or anything but a few natural epithelial cells and minute octaëdral crystals of oxalate of lime.

It seems impossible to doubt that this is a case of radical cure, twice effected in the same individual, with an interval of eleven years between the attacks. From the state of the urine three years after the second illness, it is allowable to conclude, that the albuminuria had disappeared after the former also, though it appeared not to have done so in the course of the first two years. This was one of the first cases which led me to suspect the occasional excitement of Bright's disease by mercurial action. Another, which proved fatal, happened in the hospital wards under my care about the same time.

The cases now detailed furnish, it appears to me, satisfactory evidence, that Bright's disease is capable of radical cure, even in very urgent circumstances; and it is probable that the proportion of recoveries would be much larger if the patient, in chronic cases, became sooner aware of the nature of his illness, and if his circumstances and condition of life admitted more frequently of a careful regimen after the disease has been once fairly subdued. In all instances, it is evident that recovery is very gradual, and that great patience is necessary on the part both of the patient and his physician.

LECTURE ON THE RECENT PROGRESS OF ORGANIC CHEMISTRY. BY WILLIAM GREGORY, M.D., F.R.C.P., Professor of Chemistry in the

University of Edinburgh.

(Delivered in the Hall of the Edinburgh College of Physicians,
on 14th April 1851.)

The period in which we live, viewed in reference to chemistry, is marked by the enormous development and rapid progress of organic chemistry. This period dates, properly speaking, from the time when the ultimate analysis of vege