ANATOMICAL RELATIONS 
OF 
LESIONS OF THE HEART AND THE KIDNEYS 
i N 
BRIGHTS DISEASE. 
FROM THE STUDY OF THREE HUNDRED AUTOPSIES. 
BY 
HENRY F. FORMAD, B.M., M.D., 
LECTURER ON EXPERIMENTAL PATHOLOGY AND DEMONSTRATOR OF MORBID ANATOMY IN THE 
UNIVERSITY OF PENNSYLVANIA, CORONER’S PHYSICIAN OF PHILADELPHIA, PATHOLOGIST 
. TO THE PHILADELPHIA HOSPITAL, PRESIDENT OF THE PATHOLOGICAL 
SOCIETY OF PHILADELPHIA, ETC. 
REPRINTED FROM THE 
TRANSACTIONS OF THE ASSOCIATION OF AMERICAN PHYSICIANS, 
WASHINGTON, 1889. 
PHILADELPHIA: 
WM. J. DORN AN, PRINTER. 
1889. ANATOMICAL RELATIONS 
O F 
LESIONS OF THE HEART AND THE KIDNEYS 
I N 
BRIGHT’S DISEASE. 
FROM THE STUDY OF THREE HUNDRED AUTOPSIES. 
BY 
HENRY F. FORMAD, 
LECTURER ON EXPERIMENTAL PATHOLOGY AND DEMONSTRATOR OF MORBID ANATOMY IN THE 
UNIVERSITY OF PENNSYLVANIA, CORONER’S PHYSICIAN OF PHILADELPHIA, PATHOLOGIST 
TO THE PHILADELPHIA HOSPITAL, PRESIDENT OF THE PATHOLOGICAL 
SOCIETY OF PHILADELPHIA, ETC. 
REPRINTED FROM THE 
TRANSACTIONS OP THE ASSOCIATION OP AMERICAN PHYSICIANS, 
WASHINGTON, 1889. 
PHILADELPHIA: 
WM. J. DORN AN, PRINTER. 
1889. THE ANATOMICAL RELATIONS OE LESIONS OF THE 
HEART AND THE KIDNEYS IN BRIGHT’S DISEASE. 
From the Study of Three Hundred Autopsies. 
By HENRY F. FORMAD, B.M., M.D. 
In the present paper I give an account of my studies from three 
hundred autopsy records of Bright’s disease. 
I will limit myself chiefly to the consideration of hypertrophy and 
fatty metamorphosis of the heart as occurring in this disease. There 
are a number of other points of interest that may be gleaned from 
these records, but upon which I will not dwell nowT beyond stating 
general results. 
Some of the points gained from the analysis of my tables give 
results which are at variance with those obtained from the collective 
studies of cases of Bright’s disease made by some authorities. The 
reason for this may be looked for, however, in the classification of the 
material, the direction of study, or the purpose for which any given 
class of cases had been collected, or sometimes selected. 
My studies are purely morphological, being made at the autopsy 
table and in the laboratory upon consecutive cases of Bright’s disease 
as they occurred during a given space of time. They are unbiased; 
not being a clinician, I have no theories or hypotheses to follow out, 
and refrain from making any suggestions regarding the mechanism of 
the production of cardiac and renal changes, and for the present I 
will not go into the details of the etiological relations of these affec- 
tions. 
Of the three hundred autopsies upon cases of typical Bright’s 
disease, one hundred and fifty were studied by myself post-mortem, 
and most of these also microscopically; in fact, the specimens from 4 
FOR MAD, 
every case where the naked-eye appearance was not conclusive, were 
thus examined. The source of these one hundred and fifty autopsies 
is from the coroner’s material of the city of Philadelphia, through 
the courtesy of Coroner S. H. Ashbridge, for whom, in conjunction 
with Dr. R. R. Stewart, I conduct all the autopsies of cases of 
sudden deaths or those unattended by physicians. Another source 
is private autopsies, which I frequently make at the request of phy- 
sicians. All these cases occurred in a total of eleven hundred and 
seventy-two consecutive autopsies of adults, and were executed be- 
tween September 1, 1888, and September 1, 1889. It will be seen 
from the tabulated results given below, that in general these cases are 
not unlike the hospital cases, which are not included in this series. 
The other one hundred and fifty autopsies were taken from the 
post-mortem records of the Philadelphia Hospital (the large alms- 
house hospital of this city). I abstracted them with the aid of my 
assistant in this work, J. F. Spelman. They are all cases of typical 
Bright’s disease, mostly diagnosticated as such or studied during life, 
being selected from a total of thirteen hundred autopsies from the 
hospital records stated, covering a period of five years. Many of 
them had been executed under my supervision and that of Dr. E. 0. 
Shakespeare, while the rest were clinically studied and executed by 
the members of the hospital staff, which included Drs. Tyson, Bruen, 
Osier, Musser, Wilson, Henry, Curtin, and Walker. 
These hospital records, although not sufficiently detailed regarding 
the weight of the heart and kidneys, are accurate and will serve our 
purpose. Each series of cases is separate and distinct, no cases being 
duplicated. 
Each of the two series of autopsies is recorded in detail, separately 
in the second part of this paper. 
In the preparation or collection of these records, Bright’s disease 
was taken as the starting-point or basis. All cases of kidney affections 
other than Bright’s disease, or those in which the disease did not pre- 
sent itself as fully established at the autopsy, and a few ill-recorded 
cases, were excluded. 
In the hospital and private cases the clinical diagnosis was paid 
attention to: an advantage which was not enjoyed in the coroner’s 
cases, yet, even in the latter, sometimes the most truthful of histories HEART AND KIDNEYS IN BRIGHT’S DISEASE. 
5 
were obtained under oath upon the witness stand, especially regarding 
habits of the deceased. 
In the series of my own autopsies, which were made with the 
special purpose of presenting the results in these studies, the weight 
of the heart and of the kidney were taken carefully in nearly every 
instance as stated in the records, likewise the condition of the body, 
while its weight was approximately estimated and which, I believe, in 
most cases to be an almost true estimate, being correct within the 
limits of a few pounds. Naturally the ability to do this requires 
practice. 
The estimation of the weight of the body is all-important as re- 
gards the question of the normal size of either heart or kidneys, 
because while a heart weighing twelve ounces may be called hypertro- 
phied in an individual of one hundred and twenty pounds bodily 
weight, it may be considered of normal weight in an individual weigh- 
ing two hundred pounds. My figures of the approximate weight of 
the body are satisfactory for this purpose, because a mistake within 
a few pounds (of the bodily weight) could be no definite mathematical 
factor; moreover, there are other more serious obstacles to the preci- 
sion in calculating proportions, such as the condition of nutrition of 
the body and the contents of the alimentary canal. 
In all statistics relating to the weight of the heart found in the 
literature of Bright’s disease, these points, the importance of which is 
readily seen, have not been taken into consideration by any one in this 
class of studies as far as I know. The same is true of the relation of 
the weight of the kidneys to the bodily weight in Bright’s disease. 
From the given weight of an organ a satisfactory estimate of its 
size can be made. I found the weight of organs to be a much safer 
criterion and more satisfactory than measurements, the latter being 
made by the different observers according to various scales, methods, 
and ideas, which are often quite unintelligible and useless. The heart 
muscle especially varies in thickness according to the degree of con- 
traction, the quantity of clotted blood, and the time which has elapsed 
since death. The plain statement of an experienced observer as to 
the condition of the cavities, the walls, and the approximate weight of 
the heart is more valuable than all the measurements that an inex- 
perienced and over-zealous one will present with his figures. 
From the present considerations I exclude amyloid disease of the 6 
FOKMAD, 
kidney; although belonging to the picture of Bright’s disease, there 
is a marked and nearly constant apparent absence of hypertrophy of 
the heart. This is true as far as the small size or weight of the heart 
is concerned at time of death, but if it be considered that we meet 
with it usually in scrofulous subjects, who invariably have congenitally 
small hearts, the conclusion that hypertrophy of the heart is rare in 
this affection will be found to be an error. 
The small heart of the scrofulous is subject to hypertrophy as well 
as the heart of the normal individual; but when the former hypertro- 
phies to double its original size, it may not appear any larger in volume 
than the latter, and when, in reality, enormously hypertrophied it may 
barely reach the size of what we ordinarily would call a slight hyper- 
trophy. I made some studies upon the weight of the organs, in 
relation to the size of the body, in the scrofulous, according to the 
methods of Beneke and Tlioma for establishing such weights, and paid 
especial attention to hypertrophy in amyloid disease. I shall present 
these observations on another occasion. 
Cases of congenitally small kidneys and of senile atrophy were 
carefully excluded in Series A., these autopsies having been executed 
all by myself or the organs personally studied. 
I also excluded from the present records cyanotic induration of the 
kidneys; which, as is well known, is usually the consequence of cardiac 
disease, especially valvular. I may state here that my researches 
have fully convinced me that cyanotic induration of the kidney never 
terminates in Bright’s disease, which is quite contrary to the opinion 
of some observers. I have reference to the long-standing passive 
hypersemia of the kidneys which results in cyanotic induration of 
these organs, with enlargement often to double their normal size, the 
kidneys being hard and firm and bluish-red in color. 
The alcoholic cyanosis of the kidney, another affection analogous 
morphologically to the last named, but different only in the shape 
of the organs (the “pig-backed” kidney, which I first described 
and demonstrated before this Association (see Yol. I. of Transactions), 
I also excluded). Alcoholic cyanosis is often associated with cardiac 
hypertrophy, but rarely with valvular disease. It is this affection 
which is often mistaken on the post-mortem table for, and recorded as, 
acute Bright’s disease. I doubt not that this lesion (the alcoholic 
kidney) represents the inflammatory form of Bright’s disease of HEART AND KIDNEYS IN BRIGHT’S DISEASE. 
7 
Grainger Stewart, which he records as being without albuminuria, 
without dropsy, and with large fatty livers, and which has crept nowr 
and then into the records of various observers, old and recent, as 
cases of acute Bright’s disease. I also believe some of the sub- 
divisions of the “ pluralists” on Bright’s disease, such as the “chronic 
hemorrhagic nephritis without dropsy of Weigert,” to be identical 
with my alcoholic cyanosis. 
The late stage of the alcoholic cyanosis (the oedematous form), as 
met with upon the post-mortem table, in chronic drunkards who had 
been deprived for some time of alcoholic beverages, resembling much 
the large white kidney macroscopically, is another source of error; this 
lesion I have seldom seen to give rise to left-sided hypertrophy, 
though general cardiac hypertrophy is common.1 
Amyloid kidney also closely resembles and is often mistaken for the 
large white and the fatty and contracted kidney. 
Such mistakes and the omission (to be referred to later) of some 
authors to separate the fatty and secondarily contracted kidney from 
the primarily contracted or granular kidney, cripple the statistics on 
the subject of hypertrophy of the heart quite decidedly. 
In recording my cases I have adopted the rather crude and old- 
fashioned nomenclature for the various forms of Bright’s disease, but 
one which I am sure will be readily comprehended; whereas, did I 
use the proper technical terms, misunderstanding on the part of the 
reader, as to the exact form of Bright’s disease meant, would be some- 
times liable to occur.2 
The classification adopted is as follows: 
I. The acute 'parenchymatous nephritis (syn. catarrhal, tubular, 
desquamative, croupous, scarlatinal, febrile, glomerulo-nephritis, 
acute degeneration of the kidney, acute exudative nephritis, acute 
diffuse nephritis) I will term acute Bright's disease. 
1 It is remarkable how infrequent Bright’s disease is in drunkards. I found that 
inflammatory kidney lesions generally occurred more frequently in the temperate than 
in the intemperate. Is it the constant excess of venous blood in alcoholic cyanosis of the 
kidneys that makes inflammatory changes in the latter less frequent, as it does in the 
right chambers of the heart ? 
2 I am not considering here the histology of Bright’s disease, hence it is unnecessary to 
review the anatomical and histological features of the various forms of this affection ; 
but stating the array of synonyms may prevent misunderstanding. 8 
FORMA D, 
II. The early stage of the chronic parenchymatous nephritis (syn. 
same as above qualified by u chronic”) I will invariably call large 
white kidney, which well indicates the stage of the disease. 
III. The late or contracting stage of the chronic parenchymatous 
nephritis (syn. diffuse nephritis, secondarily contracted kidney, ob- 
structive nephritis, fatty kidney, chronic diffuse nephritis with exuda- 
tion) I will designate as fatty and contracted kidney. 
IY. The chronic interstitial nephritis or primary contracted kidney 
(syn. granular, cirrhotic, and gouty kidney, renal cirrhosis, atrophic, 
lithaemic and toxaemic nephritis, and chronic diffuse nephritis without 
exudation, etc.) I will call red granular kidney, which is an old and 
comprehensive name for this affection. 
Among the most serious sins of nomenclature we find that the term 
diffuse nephritis is indifferently applied to both the fatty and con- 
tracted and the red granular kidney. 
The reasons for a separation of these two affections as distinct forms 
of Bright’s disease are quite obvious, and I put myself strongly on the 
side of those who make it, viz., the dualists.1 
For diagnostic purposes and for prognosis it is also quite essential 
that the fatty or secondarily contracted kidney should be differentiated 
from the red granular or primarily contracted kidney. Clinically it 
is, I believe, wTell established, that in the former the onset of the disease 
may nearly always be traced to acute nephritis, or at least to the large 
white kidney ; that it is liable to occur at all ages; that transitions 
from scarlatinal nephritis in the young are traced to the large white 
kidney of the adult, and to the fatty and contracted kidney of late 
life, while rarely to the very old ; that dropsy is very common in the 
1 It is interesting to observe that the father of Bright’s disease, also Grainger Stewart, 
Dickinson, Johnson, and the English school are strictly “ dualists,” being reinforced by 
the great original German workers Virchow,Traube, Senator, and Bartels; Charcot and 
Cornil in France, and in this country perhaps strongest by Tyson. The French are 
mostly “unicists” (i. e., advocates of the eventual transition of the three parenchyma- 
tous forms of nephritis into the red granular kidney), which is, however, also in accord- 
ance with the views of such prominent Germans as Frerichs, Bosenstein, Cohnheim, and 
Bamberger, and it appears also with the views of some of the New York authorities on 
the subject. 
Of late years" pluralists” have arisen, chiefly among the Germans, including 
Wagner, Weigert, and even Senator, who are inclined to ascribe every form of Bright’s 
disease to different and independent morbid processes and causes, and place several 
complications of the morbus Brightii in the field as independent subdivisions of the 
disease. HEART AND KIDNEYS IN BRIGHT’S DISEASE. 
9 
earlier stages; that polyuria is more rare, and albumin is seldom 
missed; in fact, the duration of the disease is very uncertain, a fatal 
termination being liable to occur at any time. 
On the other hand, in the red granular kidney, which is common 
in gouty and rheumatic individuals, and is so often traced to disease of 
the genito-urinary tract, the initial stage is unknown, there being 
nothing to show that an acute inflammation of the kidney ever existed. 
It rarely occurs in the young,1 being almost peculiar to middle or old 
age ; it may be of lifelong duration ; dropsy and presence of albumin 
are rare, and polyuria is prominent. 
Polyuria in the fatty and contracted kidney, if it occurs at all, is 
late; the urine may be rich in albumin, whereas, in the ever-present 
copious flow in the red granular form little or no albumin is present, 
as is well known. This, I believe to be an important diagnostic point. 
In my laboratory classes the urine examined is often from well- 
known clinical cases, and in many instances have I traced the albu- 
minous (fatty and contracted kidney) and non-albuminous polyuria 
(red granular kidney) to the post-mortem table. 
I may be permitted to introduce the following table relating to the 
more important anatomical and microscopical differences between the 
two affections referred to, because their separation is to a certain extent 
a point of issue in hypertrophy of the heart, and fatty metamorphosis 
of the cardiac muscle. 
Fatty and Contracted Kidney. 
Contraction of kidney secondary. 
Size seldom below normal. 
Capsule adherent only in places, 
seldom thickened. Surface lobulated, 
often smooth; color pale, mottled or 
yellow. 
Cysts usually large, and seldom 
numerous. Pelvis rarely dilated. 
Arterial changes rare, or not pro- 
nounced. 
Cortex often normal in size. Atro- 
phy very late. 
Red Granular Kidney. 
Contraction of kidney primary. 
Size below normal, often reduced to 
one-half, or even one-fourth. 
Capsule adherent, thickened. Sur- 
face granular, rough. Color red or 
grayish-red. 
Cysts usually small-sized and nu- 
merous. Pelvis often dilated. 
Arterial changes (endarteritis, or 
periartritis) almost invariably present. 
Cortex always much atrophied. 
1 Eight cases below 30 years will be found in my records. Histories of syphilis, 
malaria, and anaemia were conspicuous in these cases. For duration of life in Bright's 
disease, see special table. 10 
FORM AD, 
Renal epithelium much swollen, 
desquamating freely, often in a state 
of fatty degeneration, but cells always 
visible. Compound granule cells. 
Tube casts, epithelial, dark granu- 
lar, and containing compound granule 
cells, and later fat globules. 
Renal epithelium never desqua- 
mating, though it may undergo fatty 
degeneration (necrosis), and become 
diminished in size and partly lost. 
Tube casts, hyaline, pale granular, 
and waxy, but never containing cells, 
epithelial or any other. 
Note.—If the classification and the definition of Bright’s disease in its various forms 
were undisputed and a uniform nomenclature adhered to by all, then there would be 
no discrepancy in statistical results such as is seen in the literature of the subject. I 
would earnestly urge the adoption of a uniform nomenclature for the various forms of 
Bright’s disease and the abolition of some of the synonyms. Some of the latter are mis- 
leading and I have met with instances where pathologists and clinical teachers would 
designate one and the same form of Bright’s disease by entirely different names (with- 
out thinking that they were identical) and also under a certain given name affections 
entirely different from one another. Others delight in suggesting and using new names 
for the various forms without giving synonyms when writing on the subject, and 
leaving the reader to conjecture from the description which form of the affection they 
really mean. 
Analysis of the Cases. 
The three hundred autopsies from which I draw my conclusions 
(two series: A. coroner's and private cases, B. hospital cases) are, as 
stated, recorded in detail in the second part of this paper (Appendix). 
I thought it necessary and convenient to record them here, as future 
studies of the same by anyone may reveal points of interest at present 
unconsidered. Each case has a reference either to my note-book, 
to the autopsy records of the Philadelphia Hospital, or to those of the 
coroner, so that should additional information be desired it may be 
gained therefrom. 
The large general table is a summary of all the cases recorded 
in this paper, and gives the duration of life, the cause of death, 
the condition of the body, dropsy, cystic change of the kidney, 
and the prominent cardiac complications, such as hypertrophy, val- 
vular disease, fatty metamorphosis, and dilatation of the heart, as well 
as the arterial changes in each form of Bright’s disease, stating the 
number of cases. The figures expressing the percentage side by side 
with the number of cases, facilitate comparison with other statistics. 
Beside this I have compiled several special tables which give in- 
teresting data relating to hypertrophy of the heart under varying 
conditions; fatty metamorphosis of the cardiac walls, valvular disease HEART AND KIDNEYS IN BRIGHT’S DISEASE. 
11 
and pericarditis, and the weight of the heart and kidneys in each of 
these affections. 
I also present tables relating to age and sex, and further some 
interesting figures concerning the weight of the heart in relation to 
the weight of the body, and finally some data relating to the distribu- 
tion of Bright’s disease during the various periods of life. 
References will be found in the records to arterial changes and a 
summary of the various complications or concurrent affections of 
Bright’s disease. 
Conclusions. 
From the accompanying general table the following conclusions 
may be made: 
Hypertrophy of the Heart.1 
Hypertrophy of the heart in Bright’s disease generally, occurred 
in all the cases tabulated in 62 per cent., of which 34 per cent, were 
left-sided and 28 per cent, were general hypertrophy. Hypertrophy 
was absent in only 38 per cent, of all cases. 
Considering the two forms of Bright’s disease apart, we find that 
general hypertrophy coexists more frequently with parenchymatous 
nephritis, viz., in 29 per cent.; while hypertrophy of the left ventricle 
alone was met with in 26 per cent, in this form of Bright’s disease. 
Hypertrophy of the left ventricle predominates in interstitial nephritis, 
showing 44 per cent, to 26 per cent, of the parenchymatous. General 
hypertrophy occurred in interstitial nephritis in 28 per cent. 
I obtained also figures which vary somewhat in the two series of 
cases tabulated. 
Series A. Coroner’s and private cases.—Hypertrophy of heart in 
connection with the parenchymatous forms of nephritis, occurred in 54 
1 To secure the figures stated below regarding cardiac hypertrophy, each of the two 
series of cases is first considered separately, viz., by adding the total number of cases of 
parenchymatous and interstitial nephritis together and dividing by 150; the two results 
then being added and divided by two. For instance—general cardiac hypertrophy, 
Coroner’s and private cases: in parenchymatous forms of nephritis, 22 cases; in inter- 
stitial nephritis, 13 cases; a total of 35 cases, which equals 23 per cent. Hospital cases : 
parenchymatous forms, 28 cases; interstitial nephritis, 22 cases; a total of 50 cases, 
which equals 33 per cent. By adding the two results (23 per cent, and 33 per cent.) and 
again dividing by two = 28 per cent, is obtaiifed, which equals the percentage of general 
hypertrophy in the total of cases. 12 
FORM AD, 
Analysis of 300 Cases oe Bright’s 
SKRIE3 A. 
Results op Personal Observations prom Coroner’s and Private Autopsies. 
Parenchymatous Nephritis. 
Nephritis. 
Total. 
Acute 
Large 
Fatty and 
Red 
granu- 
Bright’s. 
white. 
contract’d 
lar. 
Number of eases of each form . 
10 
44 
. 46 
100 
50 
150 
Average age at time of death . 
26 
years 
34 
years 
45 
years 
52 
years 
No. 
pr. ct. 
No. 
pr. ct. 
No. 
[>r. ct. 
No. 
ir. ct. 
No: 
pr. ct. 
No. 
pr. ct. 
f uraemia, 
0 
13 
30 
19 
41 
32 
32 
15 
3° 
47 
31 
oedema of lungs, 
0 
9 
20.5 
5 
II 
14 
14 
13 
26 
27 
18 
cerebral apoplexy 
0 
0 
6 
13 
6 
6 
8 
l6 
14 
9 
Cause of 
death, 
pneumonia, 
1 
IO 
5 
11.5 
2 
4 
8 
8 
1 
2 
9 
6 
pericarditis, 
0 
8 
18 
8 
15 
16 
l6 
12 
24 
28 
18.5 
hydropericardium 
0 
5 
ii-S 
3 
7 
8 
8 
1 
2 
9 
6 
heart failure, 
0 
3 
7 
3 
7 
6 
6 
2 
4 
8 
5 
sudden. 
0 
2 
4 
3 
7 
5 
5 
£ 
16 
13 
9 
Body emaciated 
0 
3 
7 
19 
41 
22 
22 
30 
60 
52 
35 
C present, 
10 
IOO 
35 
80 
30 
65 
75 
75 
13 
26 
88 
59 
Dropsy, 
J. absent or not 
0 
9 
20.5 
16 
35 
25 
25 
37 
74 
62 
41 
( stated, 
Renal cysts, 
f present, 
0 
11 
25 
20 
44 
31 
31 
20 
40 
51 
34 
{ absent, 
10 
IOO 
33 
75 
26 
56 
69 
69 
30 
60 
99 
66 
f left ventricle, 
0 
12 
27-5 
20 
44 
32 
32 
33 
66 ) 
100 
50 
67 
33 
Hypertrophy 
oi heart, 
j general, 
| very slight, or 
1 
9 
IO 
90 
14 
18 
32 
41 
7 
19 
15 
4i 
22 
46 
22 
46 
13 
4 
26 j 
8 
l absent, 
Hypertrophy f 
with val- 
j left ventricle, 
0 
3 
7 
3 
7 
6 
6 
14 
28 ) 
42 
28 
vular 
1 general, 
0 
7 
l6 
5 
II 
12 
12 
10 
20 J 
disease, 
l 
Hypertrophy f 
without 
j left ventricle, 
0 
8 
18 
20 
44 
28 
28 
15 
3° l 
57 
38 
valvular 
disease, 
1 general 
1 
IO 
9 
20.5 
2 
4 
12 
12 
2 
4 J 
Valvular disease without hyper- 
trophy . 
4 
40 
4 
9 
4 
8 
12 
12 
4 
8 
16 
II 
Heart normal .... 
5 
50 
14 
32 
12 
26 
31 
31 
3 
6 
34 
23 
Arterial 
f present, 
0 
12 
27-5 
29 
63 
41 
41 
45 
90 
86 
57 
changes, 
( absent, 
10 
IOO 
32 
73 
17 
36 
59 
59 
5 
IO 
64 
43 
Renal arteries involved 
0 
3 
7 
4 
8 
7 
7 
41 
82 
48 
32 
f present, . 
0 
14 
32 
26 
56 
40 
40 
34 
68 
74 
49 
of heart, 
•! absent, or very 
( slight, 
10 
IOO 
30 
68 
20 
44 
60 
60 
16 
32 
76 
50 
Fatty meta- 
morphosis 
heart 
muscle, 
f present, 
0 
8 
18 
15 
33 
23 
23 
25 
50 
48 
32 
\ absent, or not 
stated. 
10 
IOO 
36 
82 
31 
67 
77 
77 
25 
50 
102 
68 
The same without hypertrophy 
0 
2 
4-5 
9 
20 
11 
II 
5 
IO 
16 
II HEART AND KIDNEYS IN BRIGHT’S DISEASE. 
13 
Disease (exclusive of Amyloid Disease). 
Series B. 
Results of the Analysis of the Autopsy Records of the Philadelphia Hospital. 
Parenchymatous 
Nephritis. 
Interstitial 
Nephritis. 
Total. 
Granu Total. 
(12 per cent 0 
all deaths.) 
Acute 
Bright’s. 
Large 
white. 
Fatty and con- 
tracted. 
Total of paren- 
chymatous. 
Red granular. 
5 
35 
35 
75 
75 
150 
300 
31 
years 
39 years 
46 years 
59 years 
No. 
pr. ct. 
No. pr. ct. 
No 
pr. ct. 
No. 
pr. ct. 
No. 
pr. ct. 
No. 
pr. ct. 
No. 
pr. ct. 
0 
9 
26 
11 
31 
20 
27 
30 
40 
50 
33 
97 
32 
2 
40 
5 
14 
4 
II 
11 
15 
7 
9 
18 
12 
45 
15 
0 
0 
1 
3 
1 
i-5 
5 
7 
6 
20 
6-5 
2 
40 
2 
6 
3 
9 
7 
9 
6 
8 
13 
9 
22 
7-5 
o 
1 
3 
2 
6 
3 
4 
4 
5 
7 
45 
35 
11.5 
o 
3 
9 
2 
6 
5 
7 
0 
5 
3 
14 
4-5 
0 
2 
6 
5 
14 
7 
9 
4 
5 
11 
7 
19 
6 
0 
2 
6 
2 
6 
4 
5 
5 
7 
9 
6 
22 
7-5 
0 
3 
9 
9 
26 
12 
l6 
14 
19 
26 
17 
78 
26 
5 
IOO 
19 
54 
13 
37 
37 
49-5 
22 
29 
59 
39-5 
147 
49 
0 
16 
46 
22 
63 
38 
5i 
53 
7i 
91 
6l 
153 
5i 
0 
4 
II 
10 
29 
14 
19 
25 
33 
39 
26 
90 
3° 
5 
IOO 
31 
89 
25 
7i 
61 
81 
50 
67 
111 
74 
210 
70 
n 
10 
20 
4 
15 
II 
43 
9 
13 
26 
37 
14 
28 
19 
37 
23 
22 
31\ 
29 ) 
37 
58 
187 
62 
4 
80 
16 
46 
13 
37 
33 
44 
30 
40 
63 
42 
113 
38 
0 
12 
34 
11 
31 
23 
3i 
29 
39 
52 
35 
94 
3i-5 
. 
20 
9 
26 
9 
26 
19 
25 
17 
23 
36 
24 
93 
3i 
1 
20 
3 
9 
3 
9 
7 
9 
12 
l6 
19 
13 
35 
11.5 
3 
60 
11 
31 
12 
34 
26 
35 
17 
23 
43 
29 
77 
26 
1 
20 
9 
26 
13 
37 
23 
3i 
48 
64 
71 
47 
157 
52 
4 
80 
26 
7 
22 
63 
52 
69 
27 
36 
79 
53 
143 
48 
1 
20 
9 
26 
14 
40 
24 
32 
27 
36 
51 
34 
125 
4i-5 
4 
80 
26 
7 
21 
60 
51 
68 
48 
64 
99 
66 
175 
58 
1 
20 
5 
14 
8 
23 
14 
19 
17 
23 
31 
20.5 
79 
26 
4 
80 
30 
86 
27 
77 
61 
8r 
58 
77 
119 
79 
221 
73-5 
1 
20 
2 
6 
3 
9 
6 
8 
14 
19 
20 
13 
36 
12 14 
FORM AD, 
per cent, of the cases,1 and in the interstitial nephritis in 92 per 
cent. 
Series B. Hospital cases. — Hypertrophy of heart in connection 
with parenchymatous nephritis occurred in 56 per cent, of all cases, 
and in the interstitial nephritis in 60 per cent.2 
Relation to Valvular Disease. 
The relation of valvular disease to the two forms of Bright’s dis- 
ease (the parenchymatous and the interstitial) appears to be an indefi- 
nite one. 
Valvular disease without hypertrophy proves to be nearly equally 
distributed between the parenchymatous and interstitial, occurring in 
the former in 12 per cent, and in the latter in 13 per cent. 
In the chronic interstitial nephritis hypertrophy of the heart with- 
out valvular disease was met with in 27 per cent, of all cases, while 
in the parenchymatous form it was 34.5 "per cent. 
Hypertrophy of the heart with valvular disease coexisted with 
chronic interstitial nephritis in 42 per cent., or nearly twice as fre- 
quently as in the parenchymatous forms in which it was 23 per cent, 
(occurring with equal frequency in the large white, and fatty and 
contracted kidneys). 
The degree of hypertrophy appears also to be influenced by valvu- 
lar disease, and still more by pericarditis, as the following results will 
show: 
Cases. Average weight of heart 
Hypertrophy without valvular disease . 
93 14 ounces. 
Hypertrophy with valvular disease 
94 17 “ 
Hypertrophy with pericarditis 
22 18 “ 
The duration of the disease and probably the age of the patient are 
evidently correlative with the degree of the hypertrophy. 
1 The cases of parenchymatous nephritis recorded in the tables, it will be remem- 
bered, all belong to the chronic form save fifteen cases which are acute Bright’s dis- 
ease. These few cases appear, moreover, nearly in equal proportion in the two series, 
so that a comparison may be fairly made. 
2 There were six cases among the Hospital records of red granular kidney in which 
the cause of death was designated senility. As there were many aged persons among 
the autopsy material of this series, I fear that some cases of senile atrophy of the 
kidneys with absence of hypertrophy of the heart, have crept into these records. This 
would explain the discrepancy in the statistical results, viz., 60 per cent, of hypertrophy 
in the Hospital cases to 92 per cent, in my own cases (in red granular kidney). HEART AND KIDNEYS IN BRIGHT’S DISEASE. 
15 
The average weight of the hypertrophied heart appears from my 
tables to be as follows in the different forms of Bright’s disease: 
Average weight. 
In acute Bright’s . 10 ounces. 
In large white kidney ....... 15 “ 
In fatty and contracted kidney . . . . . 14 “ 
In red granular kidney 17 “ 
Relation of the weight of the body to the weight of the heart.— 
That the former has a great influence upon the apparent degree ot 
the hypertrophy of the heart, may be gleaned ot the table that I sub- 
mit below, in which the important factor, the weight of the body, 
expressed in pounds, is considered side by side with the weight of the 
hypertrophied heart. 
Table showing Relation of Weight of Heart to that of Body. 
Weight of the heart as 
found. 
Large white kidneys, 
iucludiug 10 cases 
acute Briglit's disease. 
(54 cases.) 
Fatty and contracted 
kidneys. 
(46 cases.) 
Red granular 
kidneys. 
(50 cases.) 
Number 
of cases 
observed. 
Average 
weight of 
the bodies. 
Number 
of cases 
observed. 
Average 
weight of 
the bodies. 
Number 
of cases 
observed. 
Average 
weight of 
the bodies. 
Below 10 ounces . . . 
13 
132 
3 
120 
1 
190 
10-11 
“ ... 
5 
128 
7 
130 
2 
155 
11-12 
“ . . 
2 
134 
2 
135 
2 
110 
12-13 
“ ... 
6 
148 
4 
130 
3 
130 
13-14 
it 
5 
152 
4 
134 
4 
120 
14-15 
it 
3 
' 138 
4 
132 
15-16 
“ ... 
1 
145 
5 
130 
6 
143 
16-17 
u 
3 
157 
2 
140 
7 
122 
17-18 
it 
3 
146 
5 
135 
18-19 
“ 
4 
151 
2 
142 
19-20 
“ ... 
3 
150 
1 
130 
4 
138 
20-25 
it 
9 
150 
7 
152 
11 
142 
25-30 
2 
160 
5 
163 
It will be seen from this that advanced degrees of hypertrophy, 
viz., the heart weighing above 15 ounces, occurred as follows: 
Cases. 
Per cent. 
Acute Bright’s and large white kidney—heart above 15 ounces 20 
37.5 
Fatty and contracted kidney “ “ “ “ . 22 
48 
Red granular kidney “ “ “ “ . 38 
76 
Where there were large hearts, as a rule, valvular disease coexisted, 
especially when associated with the red granular kidney. Also, with 16 
FORMAD 
few exceptions, the largest hearts corresponded more or less ivith the 
largest sized bodies. 
Microscopy of the hypertrophied cardiac muscle.—There are two 
points of interest, that I will but briefly refer to. 
1. Cardiac hypertrophy depends upon simple increase in the bulk 
of the muscular fibres, viz., a simple, true hypertrophy and not upon 
any hyperplasia (increase in number) of the elements. Each indi- 
vidual muscular fibre in the hypertrophied heart shows by accurate 
micrometry to be up to twice and three times thicker and longer 
than the normal muscular fibre of the heart, and it is, therefore, not 
surprising that the latter should become twice and three times 
enlarged. 
The hyperplasia of the connective tissue, though quite marked in 
many specimens, is not an important factor in adding to the bulk or 
weight of the heart. 
2. Necrotic change of the muscular fibres was occasionally observed 
in some of the largest hearts, especially in limited areas. Yet in 
many instances this proved to be due to cadaveric change, which I 
need not explain at this place. I refer to this only because in some 
instances it may be mistaken for true ante-mortem fatty metamor- 
phosis of the cardiac m-uscle. 
Fatty Metamorphosis of Heart. 
Fatty metamorphosis of the heart in the 300 cases of Bright’s dis- 
ease tabulated in this paper, was found to be present in only 26 per 
cent., it being absent in 74 per cent. 
The distribution of fatty metamorphosis of the hypertrophied car- 
diac wall in the several forms of Bright’s disease (see tables of my 
own cases—coroner’s and private) proved to be as follows: 
Series A—Coroner’s and Private Cases. 
In the large white kidney 
Cases. 
8 
Per cent. 
18 
In the fatty and contracted kidney . 
. 15 
33 
In the red granular kidney .... 
. 25 
50 
Fatty metamorphosis, absent or not stated 
. 102 
68 
Fatty metamorphosis, without hypertrophy . 
. 16 
11 
Total of fatty metamorphosis .... 
. 48 
32 HEART AND KIDNEYS IN BRIGHT’S DISEASE. 
17 
> JO / too ±J X JJ.UOJJ VLLll> 
Cases. 
Per cent. 
In acute Bright’s disease ..... 
1 
20 
In the large white kidney .... 
5 
14 
In the fatty contracted kidney 
8 
23 
In the red granular kidney .... 
. 17 
23 
Fatty metamorphosis, absent or not stated 
. 119 
79 
Fatty metamorphosis, without hypertrophy . 
. 20 
13 
Spriest R—PhilnApI/nhin. TTnxnitnl Cases 
Cases. 
Per cent. 
Fatty metamorphosis, present . 
. 79 
26 
Fatty metamorphosis, absent . 
. 221 
74 
Grand Total. 
While it appears that fatty metamorphosis of the heart muscle 
coexists more frequently with the red granular kidney, I found that 
in many of these cases the necrotic change of the muscle was but 
slight, whereas in conjunction with the fatty and contracted kidney 
and in some non-hypertrophied hearts it was decidedly more pro- 
nounced. The typical brown atrophy of the heart occurred in my 
cases more commonly in the fatty and contracted kidney, at advanced 
age and coincident with atheroma of the coronary arteries. The pig- 
mentation around the nuclei of the muscle is also most conspicuous in 
these cases. 
Fatty metamorphosis whenever met with was fairly indicated by 
the dilatation of the cardiac walls and distinct yellow or brownish 
striations or patches beneath the endocardium and particularly in the 
columnce carnece; occurring with equal frequency in the right and 
left chambers. 
The method adopted for microscopical examination was an easy 
one and the best, viz., teasing in salt water or weak caustic soda solu- 
tion ; nearly every suspicious heart of Series A was examined while 
fresh, with the results stated in the records. Fatty infiltration and 
cirrhosis of the interstitial tissue of the cardiac walls were met with in 
six cases, combined with fatty metamorphosis. 
Arterial Changes. 
Atheroma of the aorta and some of the larger vessels was observed 
as follows : 
Cases. 
Per cent. 
In the large white kidney 
. 12 
27.5 
In the fatty and contracted kidney . 
. 29 
63 
In the red granular kidney 
. 45 
90 
Series A—Coroner's and Private Cases. 18 
FO RMAD 
Series B—Hospital Cases. 
In the large white kidney (including one of acute 
Cases. Per cent, 
Bright’s disease) 
10 23 
In the fatty and contracted kidney .... 
13 37 
In the red granular kidney ..... 
48 04 
Total in both series ..... 
157 52 
Endarteritis and periarteritis of the renal vessels were studied only 
in Series A, and showed: 
In the large white kidney 
Cases. 
3 
Per cent. 
7 
In the fatty and contracted kidney . 
4 
8 
In the red granular kidney 
. 41 
82 
It should be further noted that whereas the first two of these 
kidney lesions revealed but slight arterial changes, the red granular 
kidney showed them well pronounced. 
Arterial changes, it is seen, come prominently into considera- 
tion only in one form of Bright’s disease, viz., the red granular 
kidney, forming only a small portion of the total histological picture 
of it. It is not my object in the present paper to go into the consid- 
eration of this question. I may state, however, that Gull and Sutton 
in their excellent original work, “On the Pathology of the morbid 
state commonly called Bright’s Disease,” (vide Med.-Chir. Trans., 
vol. lv. p. 273), appear to refer exclusively to the primarily con- 
tracted kidney when they brought forward their famous “Arterio- 
capillary Fibrosis.” Some of the later writers on this subject, how- 
ever, erroneously attribute all forms of Bright’s disease to primary 
vascular changes. 
Histological studies in this direction are being conducted, and have 
been for some time past, in my laboratory by several gentlemen. The 
results of these investigations, I believe, will prove interesting when 
published. 
Complications. 
The prominent complications and concurrent affections other than 
those already given in my tables (see particularly large table), some of 
which codperated in the immediate cause of death, are distributed in 
the 300 cases of Bright’s disease recorded as follows: 
Hydrothorax 53, pleurisy 40, emphysema 32, peritonitis 21, 
syphilis 27, alcoholism 18, puerperal diseases 14, tuberculosis 13, 
meningitis 13, septicsemia 12, cirrhosis of liver 11, bronchitis 10, HEART AND KIDNEYS IN BRIGHT’S DISEASE. 
19 
ether narcosis and surgical operation 9, erysipelas 8, gastric cancer 
8, aneurism 7, senility 6, cancer of various parts 4, gastric ulcer 4, 
typhoid fever 3, gangrene 2, scarlatina 2, burns 1, etc. Often two 
or more of these conditions coexisted. 
The average weight of the kidneys in the various forms of Bright’s 
disease is of interest and is as follows (in ounces): 
Acute Bright’s disease 
Right. 
7.65 
Left. 
8.12 
Large white kidney 
6.91 
7.87 
Fatty and contracted kidney . 
4.74 
4.86 
Red granular kidney 
3.13 
3.43 
General average of 
5.61 
6.07 
Mortality or Duration of Life in Bright’s Disease as seen 
from the 300 Cases Tabulated. 
Sf.riks A 
—Private and Coroner’s Cases 
10-20 yrs. 
20-30 yrs 
30-40 yrs. 
40-50 yrs 
50-00 yrs. 
60-70 yrs. 
Over 
70 years. 
Acute Bright’s dis- ) 
ease, J 
3 
2 
3 
2 
0 
0 
0 
Large white kid- ) 
ney, j 
4 
15 
17 
6 
1 
1 
0 
Fatty and con- 1 
tracted kidney, f 
0 
4 
2 
14 
12 
3 
1 
Red granular ) 
kidney, I 
1 
4 
5 
5 
16 
15 
4 
Series B. 
• 
—Philadelphia Hospital Cases. 
Acute Bright’s dis- 1 
ease and large > 
white kidney, J 
4 
6 
12 
7 
5 
i 
1 
Fatty and con- } 
tracted kidney, j 
1 
1 
7 
7 
7 
7 
4 
Red granular 
kidney, j 
0 
3 
4 
16 
17 
18 
17 
I admit that as regards many interesting details these studies, as 
now presented, are deficient. I propose to complete them in the 
future with such additions as the continuous new supply of material 
will offer. 
The literature on these subjects is very interesting, but I shall not 
take up space with matters well known to the reader. 20 
FORM AD, 
APPENDIX. 
The following is the detailed account of 300 cases of Bright’s disease, 
summarized in the first part of this paper, extracted from a total of 2472 
consecutive autopsy records. 
Series A embraces one hundred and fifty cases from my private and coro- 
ner’s autopsies. 
Series B a like number of cases from the Philadelphia Hospital autopsies.’ 
Series A.—Results of Personal Observations from Coroner's and Private 
Autopsies, September 1, 1888, to September, 1889, inclusive. 
Total number of autopsies (upon adults) . . . . .1172 
Total number of typical Bright’s disease (exclusive of amyloid 
kidneys) 150 
Parenchymatous nephritis, includ- 
ing— 
Acute Bright’s disease 
Large white kidney . 
Fatty and contracted kidney, or 
secondary contracted kidney . 
No. of 
cases. 
10 
44 
46 
Chronic interstitial nephritis, in- 
cluding (only)— 
Red granular or cirrhotic kid- 
ney, or primarily contracted 
(atrophic) kidney . 
No. of 
cases. 
50 
Total .... 
100 
Total .... 
50 
Males ...... 
58 
Males ...... 
34 
Females 
42 
Females ..... 
16 
Average age (male and female) . 
37 
Average age (male and female) . 
51.80 
The appearance of the kidneys were in each case of acute Bright’s disease 
nearly alike, viz.: surface smooth, capsule not adherent, cortex widened, 
color red, etc. 
Case I. October 1,1888.—Male, age thirty, weight 170 pounds, bodily condition good. Cause 
of death burns. Kidneys each 9 ounces. Dropsy general. Heart weight 12 ounces. Valvular 
disease. Mitral verrucose. Hypertrophy none. Dilatation none. Death on fifth day. 
Case II. November 30, 1888.—Female, age seventeen, weight 110 pounds, bodily condition 
good. Cause of death scarlatina. Kidneys, weight right 7 ounces, left 8 ounces. Heart weight 
8% ounces. Valvular disease none. Hypertrophy none. Dilatation none. Glomerulo- 
nephritis. Septic embolic foci. 
Acute Bright’s Disease (10 Cases). 
1 In the manuscript all these cases were tabulated, but owing to the inconvenience 
of printing tables, they were transcribed and condensed to their present form. To save 
space some details had of necessity to be dispensed with. HEART AND KIDNEYS IN BRIGHT’S DISEASE. 
21 
Case III. December 30, 1888.—Male, age thirty-three, weight 180 pounds, bodily condition 
good. Cause of death erysipelas. Kidneys, weight of each 7% ounces. Dropsy general. Heart 
weight 9 ounces. Ulcerative endocarditis. Hypertrophy none. Dilatation general. Infarcts. 
Case IV. February 3,1889.—Male, age twehty-two, weight 140 pounds, bodily condition good. 
Cause of death fracture of spine. Kidneys, weight right 6% ounces, left 7 ounces. Dropsy gen- 
eral. Heart weight 10 ounces. Valvular disease none. Hypertrophy none. Dilatation none. 
Case V. March 10,1889.—Male, age forty-one, weight 200 pounds, bodily condition good. Cause 
of death ervsijielas. Kidneys, weight right 7 ounces, left 9 ounces. Dropsy general. Heart 
weight 13 ounces. Ulcerative endocarditis. Hypertrophy and dilatation' general. Hydro- 
thorax and ascites. 
Case VI. April 2, 1889.—Male, age fifteen, weight 90 pounds, emaciated. Cause of death 
purpura hemorrhagica. Kidneys each 7 ounces. Dropsy general. Heart weight 8 ounces. 
Valvular disease none. Hypertrophy none. Dilatation none. Acute meningitis. 
Case VII. April 23,1889.—Female, age thirty-three, weight 125 pounds, bodily condition good. 
Cause of death pneumonia. Kidneys each 9 ounces. Dropsy general. Heart weight 11 ounces. 
Valvular disease none. Hypertrophy slight. Dilatation general. Hvdrothorax and hydro- 
pericardium. Septic embolism and infarcts of kidneys and spleen. 
Case VIII. May 1,1889.—Female, age forty, weight 135 pounds, bodily condition good, anaemic. 
Cause of death erysipelas. Kidneys, weight right 7% ounces, left 8 ounces. Dropsy general. 
Heart weight 12 ounces. Acute endocarditis. Hypertrophy general. Dilatation general. 
Case IX, May 31, 1889.—Female, age twenty, weight 130 pounds, general condition good. 
Cause of death typhoid fever. Kidneys each 7% ounces. Dropsy general. Heart weight 8% 
ounces. Hypertrophy none. Dilatation none. Hemorrhagic infarct of spleen and kidiieys. 
Case X. June 28,1889.—Male, age eighteen, weight 140 pounds, general condition good. Cause 
of death typhoid fever. Kidneys, weight right 8Vt ounces, left 9% ounces. Dropsy general. 
Heart weight 9 ounces. Valvular disease, acute mitral. Hypertrophy none. Dilatation none. 
Acute meningitis. 
Large White Kidneys (44 Cases). 
Appearance of the kidney in all cases: surface smooth, capsule not adherent 
(with a few exceptions), cortex widened, pale and mottled, or striated. 
Case T. September 5, 188H.—Female, age twenty-nine, weight 125 pounds, bodily condition 
good. Cause of death uraemia. Kidneys each 7 ounces; smooth, non-adherent. Cysts none. 
Dropsy present. Cortex widened, pale. Heart weight 10 ounces. Valvular disease none. 
Hypertrophy none. Dilatation general. Fatty metamorphosis marked. Change in coronary 
arteries. Pleurisy. Lungs congested and cedematous. 
Case II. September 9,1888.—Male, age thirty-five, weight 160 pounds, bodily condition good, 
anaemic. Cause of death uraemia. Kidneys, weight right 8 ounces, left 9% ounces; smooth, 
non-adherent. Cysts none. Dropsy present. Cortex widened, pale. Heart weight 14 ounces. 
Valvular disease none. Hypertrophy general. Fatty metamorphosis none. Dilatation slight. 
Hydrothorax, hydropericardium. CEdema of lungs. Hydrothorax. 
Case III. September 9,1888.—Female, age twenty-two, weight 140 pounds, bodily condition 
good. Cause of death puerperal eclampsia. Kidneys, weight right 7 ounces, left 6% ounces ; 
surface smooth, 11011-adherent. Cortex widened, pale. Cysts none. Dropsy none. Heart 
weight 9% ounces. Valvular disease none. Hypertrophy none. Fatty metamorphosis none. 
Dilatation none. Arterial change none. Cerebral ansemia. 
Case IV. September 10, 1888.—Female, age twenty-five, weight 120 pounds, bodily condition 
good. Cause of death uraemia. Kidneys, weight right 7 ounces, left 8% ounces. Capsule 
slightly adherent. Cortex widened, pale. Cysts none. Dropsy general. Heart weight 10 
ounces. Valvular disease none. Hypertrophy none. Fatty metamorphosis none. Dilatation 
none. Arterial change none. 
Case V. September 10,1888.—Male, age thirty-four, weight 180 pounds, bodily condition good. 
Death sudden. Kidneys, weight right 6 ounces, left 9 ounces. Capsule smooth. Cortex en- 
larged, yellow and red. Cysts none. Dropsy present. Heart weight 24 ounces. Valvular 
disease none. Hypertrophy general. Fatty metamorphosis prominent. Dilatation general. 
Arterial change none. Cardiac muscle highly fatty. Emphysema and hydrothorax. 
Case VI. September 18, 1888.—Male, age twenty-five, weight 170 pounds, bodily condition 
good. Cause of death pneumonia. Kidneys, weight right 7 ounces, left 8% ounces. Capsule 
smooth. Cortex widened, pale and mottled. Cyst in left kidney. Dropsy (?). Heart weight 
12 ounces. Valvular disease none. Hypertrophy none. Fatty metamorphosis none. Dila- 
tation slight. Arterial change none. Acute pleurisy. 
Case VII. September 21, 1888.—Male, age twenty-seven, weight 145 pounds, bodily condition 
good. Cause of death heart failure. Kidneys, weight right 5% ounces, left 9 ounces , surface 
Tubulated, not adherent. Cortex widened, pale and mottled. Cysts none. Dropsy general. 
Heart weight 15% ounces. Valvular disease. Aorta, ulcerative endocarditis. Hypertrophy 
of left ventricle. Fatty metamorphosis none. Dilatation general. Arterial change none. 
Adhesive pericarditis. 
Case VIII. September 22,1888.—Female, age nineteen, weight 130 pounds, bodily condition 
good. Cause of death oedema of- lungs. Kidneys each 6 ounces. Capsule smooth. Cortex 
widened, i>ale. Cystic change none. Dropsy general. Heart weight 8 ounces. Valvular 22 
FOR MAD, 
disease chronic mitral. Hypertrophy none. Fatty metamorphosis none. Dilatation none 
Hemorrhagic infarct of spleen and kidney. 
Case IX. September 27, 1888.—Male, age twenty-four, weight 1-40 pounds, bodily condition 
good. Cause of death uraemia. Kidneys, weight right 6 ounces, left 7% ounces. Capsule 
smooth. Cortex widened, pale. Cysts none. Dropsy general. Heart weight 13 ounces. Val- 
vular disease aortic and mitral. Hypertrophy left ventricle. Fatty metamorphosis none. 
Dilatation right ventricle. Arterial change none. Erysipelas of face. 
Case X. September 28, 1888.—Female, age twenty-six, weight 130 pounds, well nourished. 
Cause of death oedema of lungs. Kidneys each 6% ounces. Cysts none. Dropsy general. 
Heart weight 9 ounces. Valvular disease none. Hypertrophy none. Fatty metamorphosis 
prominent. Dilatation general. Arterial change none. Broncho-pneumonia. Pleurisy. 
Case XI. October 1, 1888.—Male, age forty, tall, cachectic appearance. Cause of death 
uraemia. Kidneys, weight right 6 ounces, left 7 ounces. Cysts none. Dropsy of feet and penis. 
Heart weight 19 ounces. Valvular disease none. Hypertrophy left ventricle. Fatty meta- 
morphosis none. Dilatation none. Arterial change, aorta. Pericarditis. Pleurisy. Hydro- 
thorax. 
Case XII. Octobers, 1888.—Male, age thirty weight 150 pounds, well nourished. Cause of 
death cedema of lungs. Kidneys each 5 ounces. Cysts none. Dropsy present. Heart weight 
20 ounces. Valvular disease, aortic and mitral, acute. Hypertrophy general. Fatty meta- 
morphosis none. Dilatation none. Arterial change none. 
Case XIII. November 9, 1888. — Female, age forty-three, weight 110 pounds, emaciated. 
Cause of death oedema of brain. Kidneys, weight right 4% ounces, left 8 ounces. Cysts large 
in both. Dropsy none. Heart weight 13 ounces. Valvular disease none. Hypertrophy none. 
Fatty metamorphosis none. Dilatation general. Arterial change : aorta, coronary, and cerebral. 
History of syphilis. Chronic peritonitis. 
Case XIV. November 20, 1888.—Male, age nineteen, weight 140 pounds, well nourished. 
Cause of death cedema of lungs. Kidneys each 9 ounces. Cysts none. Dropsy present. Heart 
weight 9% ounces. Valvular disease none. Hypertrophy none. Fatty metamorphosis none. 
Dilatation none. Arterial change none. 
Case XV. November 25,1888.—Female, age thirty-five, weight 125 pounds, well nourished. 
Cause of death septicaemia. Kidneys each 8 ounces. Cysts none. Dropsy general. Heart 
weight 12 ounces. Valvular disease, aortic and mitral, slight. Hypertrophy general. Fatty 
metamorphosis (?). Dilatation general. Arterial change none. Abortion. Peritonitis. 
Case XVI. November 26, 1888.—Male, age thirty-one, weight 160 pounds, well nourished. 
Cause of death heart failure. Kidneys, weight right 9 ounces, left 10 ounces. Cysts large in 
both. Dropsy. Heart weight 16 ounces. Valvular disease none. Hypertrophy general. 
Fatty metamorphosis present. Dilatation general. Arterial change none. Hydropericardium, 
hydrothorax. 
Case XVII. December 5,1888.—Male, age thirty-three, weight 140 pounds, bodily condition 
good. Cause of death cedema of lungs. Kidneys, weight right 5% ounces, left 6 ounces. Cysts 
none. Dropsy. Heart weight 18 ounces. Valvular disease none. Hypertrophy left ven- 
tricle. Fatty metamorphosis none. Dilatation none. Arterial change none. Hydroperi- 
cardium, hydrothorax. 
Case XVIII. December 18, 1888.—Male, age thirty-nine, weight 135 pounds, bodily condition 
good, anaemic. Cause of death meningitis. Kidneys each 7% ounces. Cysts in right kidney. 
Dropsy general. Heart weight 24 ounces.- Valvular disease, mitral, acute. Hypertrophy 
general. Fatty metamorphosis none. Dilatation none. Arterial change of aorta and cerebral. 
Pericarditis and pleurisy. 
Case XIX. December 19, 1888.—Male, age thirty-one, weight 170 pounds, bodily condition 
good, anaemic. Cause of death uraemia. Kidneys weight each 8% ounces. Cysts none. Dropsy 
general. Heart weight 16% ounces. Valvular disease none. Hypertrophy left ventricle. 
Fatty metamorphosis none. Dilatation none. Arterial change none. Hydropericardium and 
hydrothorax. 
Case XX. December 24, 1888.—Female, age sixty-three, weight 190 pounds, bodily condition 
good. Cause of death uraemia. Kidneys each 7% ounces. Cysts none. Dropsy general. Heart 
weight 22 ounces. Valvular disease none. Hypertrophy general. Fatty metamorphosis none. 
Dilatation right ventricle. Arterial change, aorta and cerebral. 
Case XXI. Januarv 3, 1889.—Female, age forty-five, weight 115 pounds, emaciated, anaemic. 
Cause of death heart failure. Kidneys, weight right 6% ounces, left 8% ounces. Cysts in left 
kidney. Dropsy none. Heart weight 14 ounces, \alvular disease none. Hypertrophy 
general. Fatty metamorphosis prominent. Dilatation general. Arterial change: aorta, 
coronary, cerebral. Emphysema. Hydrothorax. Gastric ulcer. 
Case XXII. January 6, 1889.—Male, age fifty-four, weight 140 pounds, bodily condition good, 
anaemic. Cause of death uraemia. Kidneys, weight right 7% ounces, left 8% ounces. Cysts in 
left kidney. Dropsy general. Heart weight 21% ounces. Valvular disease, aortic calcification. 
Hypertrophy general. Fatty metamorphosis none. Dilatation general. Arterial change none. 
Emphysema and cedema of lungs. 
Case XXIII. February 10,1889.—Male, age thirty-four, very tall, emaciated. Cause of death 
uraemia. Kidneys each 10 ounces. Cysts in both. Dropsy general. Heart weight 21 ounces. 
Valvular disease, aortic and mitral. Hypertrophy general. Fatty metamorphosis, slight. 
Dilatation general. Arterial change: aortic, renal, and cerebral. Hydrothorax and hydro- 
pericardium. HEART AND KIDNEYS IN BRIGHT’S DISEASE. 
23 
Case XXIV. February 18. 1889.—Male, age twenty-four, weight 140 pounds, well nourished, 
anaemic. Cause of death oedema of lungs. Kidneys, weight right 8% ounces, left 7 ounces. 
Cysts in both. Dropsy general. Heart weight 13 ounces. Valvular disease none. Hypertrophy 
slight. Fatty metamorphosis some. Dilatation general. Arterial change none. Pleurisy, 
emphysema. 
Case XXV. March 4,1889.—Female, age twenty-three, weight 140 pounds, bodily condition 
good, anaemic. Cause of death puerperal eclampsia. Kidneys each 8 ounces. Cysts none. 
Dropsy general. Heart weight 10 ounces. Xo other lesions. Primipara. 
Case XXVI. March 8, 1889.—Male, age sixteen, weight 100 pounds, emaciated, anaemic. 
Cause of death uraemia. Kidneys each iy2 ounces. Cysts none. Dropsy general. Heart 
weight 13 ounces. Valvular disease, mitral, acute. Hypertrophy left ventricle. Fatty meta- 
morphosis none. Dilatation general. Arterial change none. Acute pleurisy. 
Case XXVII. March 8,1889.—Male, age thirty, weight 150 pounds, bodily condition good, 
anaemic. Cause of death cedema of lungs and uraemia. Kidneys, weight right 7 ounces, left 8 
ounces. Cysts none. Dropsy general. Heart weight 9% ounces. No other lesions. Miliary 
tuberculosis. 
Case XXIX. March 14, 1889.—Male, age thirty-six, weight 200 pounds, bodily condition good, 
anaemic. Death sudden. Kidneys each 8% ounces. Cysts none. Dropsy general. Heart 
weight 20 ounces. Valvular disease, aortic and mitral, chronic. Hypertrophy general. Fatty 
metamorphosis some. Dilatation general. Arterial change none. Pleurisy, and emphysema 
and cedema of lungs. 
Case XXX. March 20, 1889.—Female, age thirty-six, weight 120 pounds, bodily condition 
good, antemic. Cause of death uraemia. Kidneys each 6% ounces. Cysts in both. Dropsy 
general. Heart weight 10 ounces. No other lesion. 
Case XXXI. April 12,1889.—Female, age thirty-three, weight 140 pounds, bodily condition 
good. Cause of death puerperal eclampsia. Kidneys, weight right 5 ounces, left 6% ounces. 
Cysts none. Dropsy general. Heart weight 14 ounces. Valvular disease none. Hypertrophy 
left ventricle. No other lesions. 
Case XXXII. April 26, 1889.—Male, forty-two, weight 135 pounds, fat, anaemic. Cause of 
death uraemia. Kidneys each 6 ounces. Cysts, both full. Dropsy general. Heart weight 18 
ounces. Valvular disease none. Hypertrophy general. Fatty metamorphosis quite marked. 
Dilatation general. Arterial change none. Pericarditis and pleurisy. 
Case XXXIII. May 10, 1889.—Male, age thirty-four, bodily condition good, anaemic. Cause 
of death cedema of lixngs. Kidneys, weight right 8 ounces, left 8% ounces. Cysts left kidney. 
Dropsy general. Heart weight 23 ounces. Valvular disease, mitral, chronic. Hypertrophy 
general. Fatty metamorphosis none. Dilatation none. Arterial change : aorta! coronary, 
renal. 
Case XXXIV. May 12, 1889.—Male, age twenty-eight, weight 170 pounds, bodily condition 
good. Cause of death pneumonia. Kidneys, weight right 7 ounces, left 9 ounces. Cysts in left 
kidney. Dropsy general. Heart weight ounces. Valvular disease none. Hypertrophy 
left ventricle. No other lesions. Pericarditis and pleurisy. 
Case XXXV. May 12, 1889.—Male, age forty-three, weight 160 pounds, bodily condition good, 
anaemic. Cause of death general oedema. Kidneys each 6% ounces. Cysts none. Dropsy 
general. Heart weight 22 ounces. Valvular disease none. Hypertrophy left ventricle. Fatty 
degeneration slight. Dilatation general. Arterial change, aorta. Hy'drothorax and hydro- 
pericardium. 
Case XXXVI. June 10, 1889.—Female, age twenty-one, weight 135 pounds, bodily condition 
good. Cause of death puerperal septicsemia. Kidneys, weight right 8% ounces, left 9% ounces. 
Cysts none. Dropsy none. Heart weight 9% ounces. No other lesions. Peritonitis. 
Case XXXVII. June 11, 1889.—Male, age thirty-seven, medium condition. Cause of death 
cedema of lungs. Kidneys, weight right 5)4 ounces, left 1%, ounces. Cysts none. Dropsy 
none. Heart weight ounces. Valvular disease none. Hypertrophy left ventricle. Fatty 
metamorphosis none. Dilatation none. Arterial change general. History of syphilis. 
Case XXXVIII. June 13, 1889.—Female, age thirty, bodily condition good, medium sized. 
Cause of death uraemia. Kidneys, weight right 8 ounces, left 8% ounces. Cysts none. 
Dropsy general. Heart weight 11 ounces. Erysipelas. No other lesions. 
Case XXXIX. June 27, 1889.—Male, age forty-two, weight 139 pounds, bodily condition good, 
anaemic. Cause of death pneumonia. Kidneys each 7 ounces. Cysts none.' Dropsy general. 
Heart weight 9 ounces. Dilatation slight. No other lesions. Pericarditis and pleurisy. 
Case XL. June 30, 1889.—Female, age twenty-nine, weight 150 pounds, bodily condition good, 
anaemic. Cause of death fatal hemorrhage. Kidneys, weight right 7 ounces, left 8)4 ounces. 
Cysts none. Dropsy none. Heart weight 18 ounces. Valvular disease, aortic ana mitral. 
Hypertrophy general. No other lesions. Abortion. Peritonitis. 
Case XLI. July 31,1889.—Male, age twenty-nine, weight 180 pounds, bodily condition good. 
Cause of death pneumonia. Kidneys, weight right 9 ounces, left 12 ounces. Cysts none. 
Dropsy general. Heart weight 12% ounces. Valvular disease none. Hypertrophy general. 
Fatty metamorphosis none. Dilatation right ventricle. Arterial change none. Acute pleurisy. 
Case XLII. July 31. 1889.—Female, age twenty-three, weight 110 pounds, well nourished. 
Cause of death puerperal septicsemia. Kidneys each 7 ounces. Cysts none. Dropsy general. 
Heart weight 8% ounces. No other lesions. Peritonitis. Puerperal convulsions. 
Case XLIII. August 22, 1889.—Male, age twenty-seven, height 6 feet, well nourished. Cause 
of death pneumonia. Kidneys each 10 ounces. Cysts none. Dropsy general. Heart weight 
13 ounces. No other changes. Escaped drowning week previous to death. 24 
FORMAD, 
Case XLIV. August 22,1889.—Male, age thirty-four, weight 180 pounds, bodily condition good. 
Death sudden. Kidneys, weight right 8 ounces, left 9 ounces. Cysts none. Dropsy general. 
Heart weight 18 ounces. Valvular disease, chronic aortic. Hypertrophy left ventricle. Fatty 
metamorphosis none. Dilatation general. Arterial change, aortic. Pericarditis. Hydrothorax. 
Appearance of kidneys in all cases: surface Lobulated or granular, capsule 
adherent, or adherent in places, cortex atrophied, pale or yellowish, or striated. 
Case I. October 3, 1888.—Male, age thirty-eight, well nourished, medium size. Cause of 
death uraemia. Kidneys each bounces. Cysts in both. Dropsy lower extremity. Heart weight 
16% ounces. Valvular disease none. Hypertrophy left ventricle. No other lesions. Peri- 
carditis. 
Case II. October 20, 1888.—Male, age thirty-seven, large, bodily condition good. Cause of 
death uraemia Kidneys each 434 ounces. Cysts in both. Dropsy lower extremities. Heart 
weight 24 ounces. Valvular disease, aortic and mitral. Hypertrophy general. Fatty meta- 
morphosis none. Dilatation general. Arterial change, aortic. Emphysema. 
Case III. November 1, 1888.—Male, age thirty-eight, bodily condition good, medium size. 
Cause of death pneumonia. Kidneys each 534 ounces. Cysts none. Dropsy lower extremities. 
Heart weight 19 ounces. Valvular disease, mitral, acute. Hypertrophy general. No other 
lesions. 
Case IV. November 2, 1888.—Male, age forty-two, large, anaemic. Cause of death uraemia. 
Kidneys, weight right 4 ounces, left 434 ounces. Cysts in both. Dropsy general. Heart weight 
22 ounces. Valvular disease, aortic, slight. Hypertrophy left ventricle. No fatty meta- 
morphosis or dilatation. Arterial change general. History of syphilis. Emphysema. Hydro- 
thorax. 
Case V. November 16, 1888.—Female, age thirty-five, weight 120 pxmnds, large, anaemic. 
Cause of death oedema of the lungs. Kidneys, weight right 3 ounces, left 434 ounces. Cysts 
none. Dropsy general. Heart weight 10 ounces. Valvular disease none. Hypertropihy none. 
Fatty metamorphosis none. Dilatation general. Arterial change none. Acute peritonitis and 
ovaritis. 
Case VI. November 19, 1888.—Female, age thirty-three, weight 130 pounds, large, amemic. 
Cause of death uraemia. Kidneys, weight right 334 ounces, left 534 ounces. Cysts present. 
Dropsy general. Heart weight 1034 ounces. Valvular disease, aortic, acute. Hypertrophy left 
ventricle. Fatty metamorphosis none. Dilatation right ventricle. Arterial change none. 
Case VII. November 20, 1888.—Female, age fifty, emaciated, tall. Cause of death exhaustion 
from cancer of uterus. Kidneys, weight right 434 ounces, left 5 ounces. Cysts large in left 
kidney. Dropsy none. Heart weight 1534 ounces. Valvular disease none. Hypertrophy left 
ventricle. Fatty metamorphosis (?). Dilatation some. Arterial change none. 
Case VIII. November 24,1888.—Female, age fifty-one, weight 130 pounds, emaciated. Cause 
of death cederna of lungs. Kidneys each 5 ounces. Cysts in left kidney large. Dropsy present. 
Heart weight 15 ounces. Valvular disease none. Hypertrophy left ventricle. Fatty meta- 
morphosis none. Dilatation left ventricle. Arterial change none. Pleurisy, salpingitis. 
Case IX. December 1, 1888.—Female, age forty-six, bodily condition good, medium size. 
Cause of death uraemia. Kidneys, weight right 5 ounces, left 4 ounces. Cysts large in both. 
Dropsy. Heart weight 18 ounces. Valvular disease, slight aortic calcification. Hypertrophy 
left ventricle. Fatty metamorphosis none. Dilatation right ventricle. Arterial change, 
aortic. 
Case X. Jauuary 3,1889.—Female, age forty-four, small, emaciated. Cause of death cerebral 
apoplexy. Kidneys, weight right 4 ounces, left 7 ounces. Cysts none. Dropsy slight. Heart 
weight 12 ounces. Valvular disease none. Hypertrophy hone. Fatty metamorphosis well 
marked. Dilatation general. Arterial change, aortic, coronary, and cerebral. History of 
syphilis. Bronchitis. 
Case XI. January- 4, 1889.—Male, age forty-three, weight 130 pounds, bodily condition good, 
anaemic. Cause of death uraemia. Kidneys, weight right 4*4 ounces, left 5 ounces. Cysts 
none. Dropsy lower extremities. Heart weight 14 ounces. Valvular disease, chronic aortic. 
Hypertrophy left ventricle. Fatty metamorphosis slight. Dilatation general. Arterial change 
general. Pericarditis. Pleurisy chronic. 
Case XII. January 6. 1889.—Male, age twenty-eight, weight 140 pounds, bodily condition 
good. Cause of death uraemia. Kidneys each 4% ounces. Cysts none. Dropsy general. Heart 
weight 1134 ounces. No other lesions. * Surgical operation. 
Case XIII. January 10 1889.—Female, age fifty-two, weight 170 pounds, bodily condition 
good. Cause of death cerebral apoplexy. Kidneys, weight right 5 ounces, left 6 ounces. Cysts 
none. Dropsy none. Heart weight 21 ounces. Valvular disease none. Hypertrophy left ven- 
tricle. Fatty metamorphosis none. Dilatation none. Arterial change, aortic and cerebral. 
Pericarditis.* Pleurisy and cirrhosis of liver. 
Case XIV. January 14, 1889.—Male, age forty-four, large, bodily condition good. Cause of 
death uraemia. Kidneys each 634 ounces. Cysts in both, large. Dropsy. Heart weight 21 ounces. 
Valvular disease, mitral, chronic. Hypertrophy general. Fatty metamorphosis none. Dilata- 
tion general. Arterial change, aortic. Emphysema and bronchitis. 
Fatty and Contracted Kidney (46 Cases). HEART AND KIDNEYS IN BRIGHT’S DISEASE. 
25 
Case XV. February 4, 1889.—Female, age fifty-two, weight 130 pounds, emaciated, anaemic. 
Cause of death uraemia. Kidneys, weight right 5 ounces, left 6 ounces. Cysts large in both. 
Dropsy none. Heart weight 10 ounces. Valvular disease none. Hypertrophy none. Fatty 
metamorphosis. Brown atrophy. Dilatation general. Arterial change : aortic, coronary, and 
cerebral. Pleurisy, chronic, and emphysema. 
Case XVI. February 24, 1889.—Male, age forty-five, weight 135 pounds, emaciated, anaemic. 
Cause of death cerebral apoplexy. Kidneys each 5 ounces. Cysts large in both. Dropsy 
general. Heart weight 16 ounces. Valvular disease none. Hypertrophy left ventricle. Fatty 
metamorphosis none. Dilatation slight. Arterial changes (?). Hydropericardium, hydio- 
thorax. 
Case XVII. February 25,1889.—Female, age thirty-nine, weight 140 pounds, bodily condition 
good, anaemic. Cause of death oedema of the lungs. Kidneys each 4% ounces. Cysts present. 
Dropsy lower extremities. Heart weight 13 ounces. Valvular disease none. Hypertrophy 
general. Fatty metamorphosis slight. Dilatation general. Arterial change, coronary. Peri- 
tonitis. Meningitis. 
Case XVIII. February 26, 1889.—Female, age twenty-four, weight 130 pounds, emaciated. 
Cause of death uraemia (?) and septicaemia. Kidneys, weight right 5ounces, left 6)4 ounces. 
Cysts none. Dropsy none. Heart weight 10 ounces. No other lesions. Puerperal hemor- 
rhages. Phthisis. 
Case XIX. February 26, 1889.—Male, age thirty, weight 180 pounds, bodily condition good. 
Cause of death heart failure. Kidneys each 514 ounces. Cysts none. Dropsy general. Heart 
weight 22 ounces. Valvular disease none, hypertrophy general. Fatty metamorphosis (?). 
Dilatation general. Arterial change none. Adhesive pericarditis. 
Case XX. March 5, 1889.—Male, age sixty-two, weight 130 pounds, bodily condition good. 
Cause of death ether. Kidneys each 4 ounces. Cysts none. Dropsy none. Heart weight 12 
ounces. Valvular disease, mitral. Hypertrophy none. Fatty metamorphosis, brown atrophy. 
Dilatation general. Arterial change : aortic, coronary, and cerebral. Emphysema. 
Case XXI. March 9, 1889.—Male, age sixty, 'weight 155 pounds, anamic. Cause of death 
cerebral apoplexy. Kidneys each 5 ounces. Cysts numerous in both. Dropsy none. Heart 
weight 17yi ounces. Valvular disease, aortic calcification. Hypertrophy left ventricle. Fatty 
metamorphosis none. Dilatation general. Arterial change : aortic, coronary, and cerebral. 
Pleurisy, oedema of the lungs. Hydrothorax. 
Case XXII. March 10, 1889.—Male, aged fifty-one, small, emaciated. Cause of death cerebral 
apoplexy. Kidneys, weight right 4% ounces, left 5*4 ounces. Cysts large in both. Dropsy 
lower extremities. Heart weight 14 ounces. Valvular disease none. Hypertrophy left ven- 
tricle. Fatty metamorphosis (?.). Dilatation none. Arterial changes: aortic and cerebral. 
Case XXIII. March 14, 1889.—Female, age fifty, weight 155 pounds, bodily condition good, 
anamic. Cause of death uramia. Kidneys each 4)4 ounces. Cysts large in both. Dropsy 
lower extremities. Heart weight 13 ounces. Valvular disease none. Hypertrophy left ven- 
tricle. Fatty metamorphosis some. Dilatation right ventricle. Arterial change: aortic, 
cerebral, and renal. Hemorrhagic infarcts. Peritonitis. 
Case XXIV. March 24, 1889.—Male, age forty, weight 170 pounds, bodily condition good. 
Cause of death uramia. Kidneys, weight right 5 ounces, left 5)4 ounces. Cysts present. 
Dropsy general. Heart weight 30 ounces. Valvular disease none. Hypertrophy left ventricle. 
Fatty metamorphosis none. Dilatation general. Arterial changes none. Adhesive pericar- 
ditis. Pleurisy and bronchitis. Gastric ulcer. 
Case XXV. April 1,1889.—Male, age fifty-four, weight 135 pounds, emaciated. Cause of death 
cholestamia. Kidneys, weight right 4 ounces, left 5 ounces. Cysts in both. Dropsy general. 
Heart weight 10 ounces. Valvular disease none. Hypertrophy none. Fatty metamorphosis 
some. Dilatation general. Arterial change: aortic, coronary, and cerebral. Jaundice. 
Cirrhosis and atrophy of liver. Emphysema. Ilydrothorax. 
Case XXVI. April 2, 1889.—Male, age fifty-three, weight 140 pounds, emaciated. Cause of 
death uraemia. Kidneys each 6 ounces. Cysts in both. Dropsy general. Heart weight 12 
ounces. Valvular disease, mitral, chronic. Hypertrophy slight, general. Brown atrophy. 
Dilatation general. Arterial change: aortic, coronary, and cerebral. Cancer of stomach. 
Emphysema. Hydrothorax. 
Case XXVII. April 7, 1889. — Female, age forty-eight, bodily condition gcod, medium. 
Cause of death oedema of lungs. Kidneys each 5)4 ounces. Cysts in both. Dropsy some. 
Heart weight 11 ounces. Valvular disease none. Hypertrophy none. Fatty metamorphosis 
present. Dilatation general. Arterial change : aortic, coronary', and cerebral. 
Case XXVIII. May 4, 1889.—Male, age fortyt-hree, small, emaciated, and anaunic. Cause of 
death uraemia. Kidneys each 4 ounces. Cysts large in right kidney. Dropsy none. Heart 
weight 21 ounces. Valvular disease none. Hypertrophy left ventricle. No other lesions. 
Case XXIX. May 6, 1889.—Female, age fifty, small, emaciated, and anaemic. Cause of death 
cerebral apoplexy. Kidneys each 5 ounces. Cysts none. Dropsy none. Heart weight 10 
ounces. Valvular disease none. Hypertrophy left ventricle. Fatty metamorphosis none(?). 
Dilatation none (?). Arterial changes: aortic, cerebral, and coronary. Organs not obtained. 
Case XXX. May 16, 1889.—Female, age thirty-nine, weight 110 pounds, small, emaciated. 
Death sudden. Kidneys each 4% ounces. Cysts none. Dropsy present. Heart weight 9 
ounces. Valvular disease, mitral, chronic. Hypertrophy none. Fatty metamorphosis promi- 
nent. Dilatation general. Arterial change : aortic, coronary, and cerebral. Epithelioma of 
womb. Peritonitis. 
Case XXXI. June 3, 1889.—Female, age forty-one, weight 121 pounds, small, emaciated. 
Cause of death pneumonia. Kidneys, weight right 4 ounces, left 4% ounces. Cysts present. 26 
FOR MAD, 
Dropsy none. Heart weight 8 ounces. Valvular disease, aortic, slight. Hypertrophy none. 
Fatty metamorphosis none. Dilatation some. Arterial change none. 
Case XXXII. June 24,1889.—Female, age forty-nine, weight 140 pounds, fair. Death sudden. 
Kidneys, weight right 3% ounces, left 4% ounces. Cysts in both. Dropsy none. Heart weight 
15% ounces. Valvular disease, mitral, chronic. Hypertrophy general. Fatty metamorphosis (?). 
Dilatation general. Arterial change : aortic, coronary, and cerebral. Hydrothorax. 
Case XXXIII. June 27,1889.—Male, age forty-two, six feet two inches in height, emaciated. 
Cause of death unemia. Kidneys, weight right 4 ounces, left 4% ounces. Cysts large in left 
kidney. Dropsy none. Heart weight 21 ounces. Valvular disease none. Hypertrophy left 
ventricle. Fatty metamorphosis none. Dilatation none. Arterial change: aortic and cerebral. 
Emphysema. Meningitis. Hydrothorax. 
Case XXXIV. July 1, 1889.—Male, age thirty-nine, bodily condition good, medium size. 
Cause of death oedema of lungs. Kidneys, weight right 5% onnces, left 6 ounces. Cysts none. 
Dropsy general. Heart weight 17 ounces. Valvular disease none. Hypertrophy left ventricle. 
No other changes. Hydrothorax, hydropericardium, pleurisy. 
Case XXXV. July 6,1889.—Male, age thirty, weight 130 pounds, emaciated. Cause of death 
uraemia. Kidneys, weight right 3% ounces, left 4% ounces. Cysts in both. Dropsy present. 
Heart weight 15 ounces. Valvular disease none. Hypertrophy left ventricle. No other 
changes. Hydrothorax, pleurisy, and hydropericardium! 
Case XXXVI. July 9, 1889.—Male, age thirty-six, weight 150 pounds, bodily condition good. 
Cause of death uraemic coma. Kidneys, weight right 4 ounces, left 4% ounces. Cysts none. 
Dropsy general. Heart weight 18 ounces. Valvular disease none. Hypertrophy left ventricle. 
Fatty 'metamorphosis none. Dilatation slight. Arterial change, aortic. Hydrothorax. 
Case XXXVII. July 9, 1889.—Female, age fifty-two, weight 120 pounds, emaciated. Cause of 
death heart failure. Kidneys, weight right 7 ounces, left 5 ounces. Cysts in right kidney. 
Dropsy lower extremities. Heart weight 15 ounces. Valvular disease, aortic, chronic. Hyper- 
trophy left ventricle. Fatty metamorphosis none. Dilatation right ventricle. Arterial 
changes: aortic and coronary. Pericarditis. 
Case XXXVIII. July 12, 1889—Male, age thirty-five, weight 179 pounds, bodily condition 
good. Death sudden. Kidneys each 4% ounces. Cysts p esent. Dropsy lower extremities. 
Heart weight 17 ounces. Valvular disease none. Hypertrophy left ventricle. Fatty meta- 
morphosis some. Dilatation left ventricle. Arterial changes: general, slight. Hydroperi- 
cardium and hydrothorax. 
Case XXXIX. July 26, 1889.—Female, age forty-six, weight 190 pounds, fat. Cause of death 
pachymeningitis. Kidneys, weight right 6 ounces, left 7 ounces. Cysts none. Dropsy none. 
Heart weight 15% ounces. Valvular disease none. Hypertrophy left ventricle. Fatty meta- 
morphosis none. No other changes. History of sunstroke. 
Case XL. August 10,1889.—Female, age forty-six, weight 140 pounds, emaciated. Cause of 
death uraemia. Kidneys, weight right 5% ounces, left 6 ounces. Cysts present. Dropsy lower 
extremities. Heart weight 10 ounces. Valvular disease none. Hypertrophy none. Brown 
atrophy. Dilatation general. Arterial change: aortic, coronary, and cerebral. Pericarditis, 
pleurisy. Meningitis. Phthisis. 
Case XLI. August 13,1889.—Male, age twenty-seven, small. Cause of death uraemia. Kidneys, 
weight right 4% ounces, left 5 ounces. Cystic change none. Dropsy lower extremities. Heart 
weight 14 ounces. Valvular disease, mitral. Hypertrophy general. No other changes. Peri- 
carditis, pleurisy. 
Case XLII. August 24,1889.—Male, fifty-six, medium size. Cause of death cerebral apoplexy. 
Kidneys each 4% ounces. Large cyst in left kidney. Dropsy lower extremities. Heart weight 
13 ounces. Valvular disease, aortic calcification. Hypertrophy slight. Fatty metamorphosis (?). 
Dilatation left ventricle. Arterial change aortic. Pericarditis, pleurisy, meningitis. 
Case XLIII. August 26, 1889.—Female, age twenty-three, weight 139 pounds, bodily condition 
good. Cause of death puerperal eclampsia. Kidneys each 5 ounces. Cysts none. Dropsy 
general. Heart weight 9 ounces. Dilatation general. No other changes. 
Case XLIV. August 29,1889.—Male, age fifty, weight 150 pounds, emaciated. Found dead in 
bed. Kidneys, weight right 4% ounces, left 3% ounces. Cysts large in right kidney. Dropsy 
none. Heart weight 16 ounces. Valvular disease none. Hypertrophy left ventricle. Fatty 
metamorphosis (?). Dilatation none. Arterial change: aortic and cerebral. (Edema of brain. 
Case XLV. August 81, 1889.—Male, age seventy-four, medium size. Cause of death heart 
failure. Kidneys each 4% ounces. Cysts in both. Dropsy none. Heart weight 14 ounces. 
Valvular disease, aortic, slight. Hypertrophy general. Brown atrophy. Dilatation general. 
Arterial change : coronary and cerebral. 
Case XLVI. August 31,1889. —Female, age sixty-five, tall and lean. Cause of death hemor- 
rhage and pachymeningitis. Kidneys each 4 ounces. Cysts present. Dropsy general. Heart 
weight 12 ounces. Valvular disease, aortic, slight. Hypertrophy slight. Fatty metamorphosis 
some. Dilatation general. Arterial change : aortic, coronary, and cerebral. HEART AND KIDNEYS IN BRIGHT’S DISEASE. 
27 
Red Granular or Primary Contracted Kidney (50 Cases). 
Appearance of the kidneys in nearly all cases alike, viz.: capsule adherent, 
surface granular, red or grayish-brown, cortex atrophied, etc. 
Case I. September 2,1888.—Female, age sixty-five, weight 130 pounds, bodily condition good. 
Cause of death cerebral apoplexy. Kidneys each 3 ounces. Cysts minute. Dropsy none. Heart 
weight 12% ounces. Valvular disease, senile calcification! Hypertrophy general. Brown 
atrophy. Dilatation general. Arterial change: coronary, cerebral, and renal. Atrophy of 
liver. Fibroid of uterus. 
Case II. September 6, 1888.—Male, age sixty, weight 130 pounds, emaciated. Death sudden. 
Kidneys, weight right 3% ounces, left 3% ounces. Cysts minute. Dropsy none. Heart weight 
12 ounces. Valvular disease none. Hypertrophy general. Fatty metamorphosis present. 
Dilatation general. Arterial change same as last. Emphysema. 
Case III. September 10, 1888.—Male, thirty-four, weight 140 pounds, emaciated. Cause of 
death meningitis. Kidneys weight right 2%’ ounces, left 3%ounces. Cysts minute. Dropsy 
none. Heart weight 28% ounces. Valvular disease, aortic. Hypertrophy left ventricle. Fatty 
metamorphosis present. Dilatation right side. Arterial change : aortic, coronary, cerebral, and 
renal. Cirrhosis of liver. Hydrothorax. History of syphilis. 
Case IV. September 20, 1888.—Female, age twenty-one, small, anaemic. Cause of death 
urtemia. Kidneys, weight right 3 ounces, left 2% ounces. Cysts none. Dropsy none. Heart 
weight 16 ounces. Valvular disease none. Hypertrophy left ventricle. Fatty metamorphosis 
none. Dilatation slight. Arterial changes general. History of syphilis. 
Case V. September 28, 1888.—Male, age fifty-four, weight 150 pounds, anaemic, muscular. 
Cause of death uraemia. Kidneys each 3% ounces. Cysts in right kidney. Dropsy present. 
Heart weight 22 ounces. Valvular disease, aortic calcification. Hypertrophy left ventricle. 
Fatty metamorphosis present. Dilatation left side. Arterial change: aortic, renal, and 
coronary. Chronic pleurisy. Aneurism, aorta. 
Case VI. October 16, 1888.—Male, age twenty-four, weight 150 pounds, muscular. Cause of 
death oedema of lungs. Kidneys, weight right 2% ounces, left 3% ounces. Cysts none. Dropsy 
none. Heart weight 15% ounces. Valvular disease none. Hypertrophy left ventricle. Fatty 
metamorphosis none. Dilatation right side. Arterial change slight, general. Rheumatism in 
family. Pericarditis. Cirrhosis of liver. Emphysema. Pleurisy. 
Case VII. October 17,1888.—Male, age fifty-seven, weight 130 pounds, emaciated. Cause of 
death oedema of lungs. Kidneys each 3% ounces. Cysts none. Dropsy none. Heart weight 
16 ounces. Valvular disease, aortic calcification. Hypertrophy left ventricle. Fatty meta- 
morphosis present. Dilatation right side. Arterial change, coronary. Emphysema and peri- 
carditis. Pleurisy. 
Case VIII. October 25,1888—Male, age sixty-four, weight 140 pounds, emaciated. Cause of 
death uraemic convulsions. Kidneys each 2% ounces. Cysts minute. Dropsy none. Heart 
weight 20 ounces. Valvular disease' none. Hypertrophy general. Fatty metamorphosis none. 
Dilatation general. Arterial change : aortic, renal, and coronary. Emphysema, pleurisy. 
Case IX. October 28,1888.—Male, age twenty-eight, weight 135 pounds, emaciated. Cause of 
death uraemia. Kidneys each 2% ounces. 'Cysts none. Dropsy slight. Heart weight 22 
ounces. Valvular disease none. Hypertrophy left ventricle. Fatty metamorphosis marked. 
Dilatation general. Arterial change'general. Cystitis and stricture. 
Case X. October 29,1888.—Male, age fortv-five, weight 150 pounds, fairly nourished. Cause 
of death cerebral apoplexv. Kidnevs, weight right 2% ounces, left 3% ounces. Cysts none. 
Dropsv none. Heart weight 19 ounces. Valvular disease none. Hypertrophy left ventricle. 
Fatty metamorphosis none. Dilatation none. Arterial change general. Aneurism, aorta. 
Case XI. November 1,1888.—Male, age sixty, weight 120 pounds, emaciated. Cause of death 
oedema of lungs. Kidneys, weight right 3 ounces, left 3% ounces. Cysts small and numerous. 
Dropsy present. Heart weight 20 ounces. Valvular disease, aortic calcification. Hypertrophy 
left ventricle'. Fatty metamorphosis general. Dilatation right side. Arterial change general. 
Chronic pleurisy and pericarditis. 
Case XII. November 4, 1888.—Male, age sixty, weight 130 pounds, emaciated. Cause of death 
• oedema of lungs. Kidneys each 3% ounces. Cysts none. Dropsy present. Heart weight 17 
ounces. Valvular disease, aortic calcification. Hypertrophy left ventricle. Fatty meta- 
morphosis present. Dilatation general and great. Arterial change general. Heart-muscle 
very fatty. Emphysema. Hydrothorax. 
Case XIII. November 8, 1888.—Male, age fifty-one, weight 135 pounds, emaciated. Death 
sudden. Kidneys, weight right 4 ounces, left 5 ounces. Cysts none. Dropsy none. Heart 
weight 25 ounces. Valvular disease, mitral, chronic. Hypertrophy general. Fatty meta- 
morphosis none. Dilatation general. Arterial change, aortic and renal. Chronic pleurisy. 
Bronchiectasis. History of syphilis. 
Case XIV. November 9, 1888.—Female, age seventy-three, weight 130 pounds, emaciated. 
Cause of death cerebral apoplexy. Kidneys each 3% ounces. Cysts none. Dropsy none. Heart 
weight 15% ounces. Valvular disease none. Hypertrophy left ventricle. Fatty metamorphosis 
none. Dilatation none. Arterial change aortic, general. Cirrhosis of liver. Emphysema, 
chronic pleurisy. Cirrhosis of liver. 28 
FORMAD, 
Case XV. November 9,1888.—Female, age'forty-six, weight 140 pounds, emaciated. Cause of 
death cedema of lungs, uraemia. Kidneys each 3% ounces. Cysts and dropsy present. Heart 
weight 22 ounces. Valvular disease, mitral. Hypertrophy general. Fatty metamorphosis 
none. Dilatation none. Arterial change, aortic arid renal. Chronic pericarditis and pleurisy. 
Case XVI. November 15,1888.—Female, age fifty-nine, weight 110 pounds, much emaciated. 
Death sudden. Kidneys each 2% ounces. Cysts none. Dropsy none. Heart weight 13 ounces. 
Valvular disease none. Hypertrophy left ventricle. Fatty irietamorphosis none. Dilatation 
none. Arterial change general but slight. Pachymeningitis. 
Case XVII. November 19,1888.—Male, age sixty-five, weight 135 pounds, emaciated. Cause of 
death uraemic convulsions. Kidneys, weight right 2 ounces, left 4 ounces. Cysts present. 
Dropsy none. Heart weight 16% ounces. Valvular disease, aortic stenosis, calcified. Hyper- 
trophy left ventricle. Fatty metamorphosis present. Dilatation general. Arterial change 
general. History of syphilis. 
Case XVIII. November 22,1888.—Female, age sixty-six, weight 120 pounds, emaciated. Cause 
of death uraemia. Kidneys each 4 ounces. Cysts none. Dropsy of feet. Heart weight 17 ounces. 
Valvular disease none. Hypertrophy left ventricle. Fatty metamorphosis none. Dilatation 
left side. Arterial change general. History of syphilis. 
Case XIX. November 30, 1888.—Male, age sixty, weight 180 pounds, bodily condition good. 
Cause of death cedema of brain and lungs. Kidneys each 4% ounces. Cysts none. Dropsy 
present. Heart weight 24 ounces. Valvular disease hone. Hypertrophy left ventricle. Fatty 
metamorphosis some. Dilatation general. Arterial change general. Chronic pericarditis and 
pleurisy. 
Case XX. December 2, 1888.—Male, age thirty-three, weight 150 pounds, well nourished. 
Anaemia and history of malaria. Cause of death oedema of lungs. Kidneys each 4 ounces. 
Cyst in left kidney. Dropsy none. Heart weight 17% ounces. Valvular disease none. Hyper- 
trophy left ventricle. Fatty metamorphosis none. Dilatation general. Arterial change general. 
Rheumatism, lead colic. 
Case XXI. December 8,1888.—Male, age sixty-six, weight 120 pounds, well nourished. Cause 
of death cerebral apoplexy. Kidneys, weight right 3% ounces, left 3% ounces. Cysts present. 
Dropsy none. Heart weight 25 ounces. Valvular disease, aortic and mitral. Hypertrophy 
general. Fatty metamorphosis none. Dilatation general. Arterial change general. Hydro- 
pericardium. hydrothorax, emphysema. Gastric cancer. 
Case XXII. December 10, 1888.—Female, age thiriy-two, weight 100 pounds, emaciated, mus- 
cular. Cause of death uraemia. Kidneys each 2% ounces. Cysts none. Dropsy present. Heart 
weight 17 ounces. Valvular disease, aortic, acute. Hypertrophy left ventricle. Fatty meta- 
morphosis none. Dilatation none. Arterial change slight but general. History of syphilis. 
Case XXIII. December 13,1888.—Female, age forty-six, weight 155 jxmnds, bodily condition 
good. Cause of death uraemia. Kidneys, weight right 3 ounces, left 4 ounces. Cysts none. 
Dropsy present. Heart weight 17% ounces. Valvular disease, aortic and mitral slight. Hyper- 
trophy left ventricle. Fatty metamorphosis none. Dilatation general. Arterial change 
general. Hydropericardium and hydrotnorax. 
Case XXIV. December 29,1888.—Male, age fifty-eight, weight 155 pounds, bodily condition 
good. Death sudden. Kidneys, weight right 2% ounces, left 3% ounces. Cysts minute. 
Dropsy none. Heart weight 26 ounces. Valvular disease, aortic calcification. Hypertrophy 
left ventricle. Fatty metamorphosis none. Dilatation general. Arterial change general. 
Hydronephrosis. Hydrothorax. 
Case XXV. January 5, 1889.—Male, age seventy, weight 150 pounds, emaciated. Death 
sudden. Kidneys, weight right 2% ounces, left 2% ounces. Cysts none. Dropsy none. Heart 
weight 15 ounces. Valvular disease, aortic and mitral calcification. Hypertrophy general. 
Brown atrophy. Dilatation general. Arterial change general. Emphysema. History of 
syphilis. 
Case XXVI. January 24, 1889.—Female, age forty-nine, weight 135 pounds, emaciated. Cause 
of death uraemia. Kidneys each 2% ounces. Cysts none. Dropsy none. Heart weight 16 
ounces. Valvular disease none. Hypertrophy left ventricle. Fatty metamorphosis none. 
Dilatation none. Arterial change aortic and renal. Gastric ulcer. 
Case XXVII. January 30, 1889.—Female, age nineteen, weight 120 pounds, small. Cause of 
death uraemia. Kidneys, weight right 4 ounces, left 5 ounces. Cysts none. Dropsy none. 
Heart weight 13 ounces. Valvular disease none. Hypertrophy left ventricle. Fatty meta- 
morphosis none. Dilatation none. Arterial change general. History of syphilis. 
Case XXVIII. January 31, 1889.—Male, age fifty-two, weight 160 pounds, bodily condition 
good. Cause of death oedema of lungs. Kidneys, weight right 4% ounces, left 2% ounces. 
Cysts present. Dropsy of extremities. Heart weight 23 ounces. Valvular disease, aortic and 
mitral, slight. Hypertrophy left ventricle. Fatty metamorphosis none. Dilatation general. 
Arterial change general. Pleurisy and cedema of brain. Aneurism of aorta. 
Case XXIX. February 2, 1889.—Male, age forty-five, weight 140 pounds, bodily condition 
good. Cause of death meningitis and cedema of brain. Kidneys, weight right 2% ounces, left 
4 ounces. Cysts present. Dropsy of extremities. Heart weight 10 ounces. Arterial change 
general. No other lesions. Syphilis and pleurisy. Hydrothorax. 
Case XXX. March 10,1888.—Male, age sixty-five, weight 170 pounds, emaciated. Cause of 
death heart failure. Kidneys, weight right i% ounces, left 3 ounces. Cysts none. Dropsy 
none. Heart weight 19 ounces. Valvular disease, aortic, chronic. Hypertrophy general. 
Dilatation general. Fatty metamorphosis pronounced. Arterial change general. Emphysema 
and pleurisy. HEART AND KIDNEYS IN BRIGHT’S DISEASE. 
29 
Case XXXI. April 4, 1889.—Male, age sixty, small and emaciated. Cause of death cerebral 
apoplexy. Kidneys each 4 ounces. Cysts present. Dropsy none. Heart weight 20 ounces. 
Valvular disease, aortic, chronic. Hypertrophy left ventricle. Fatty metamorphosis slight. 
Arterial change, aortic. Dilatation slight. Pericarditis and pleurisy. Emphysema. 
Case XXXII. April 15, 1889.—Male, age sixty-one. well nourished, anaemic, weight 190 
pounds. Death sudden. Kidneys each 2% ounces. Cysts present. Dropsy present. Heart 
weight 9 ounces. Valvular disease, mitral, chronic. Hypertrophy none. Brown atrophy. 
Dilatation general. Arterial change, aortic. History of syphilis. 
Case XXXIII. April 26,1889.—Male, age fifty-nine, small, emaciated. Cause of death uraemia. 
Kidneys, weight right 1% ounces, left 3 ounces. Cysts present. Dropsy slight. Heart weight 
19 ounces. Valvular disease, aortic, chronic. Hypertrophy left ventricle. Fatty metamorphosis 
none. Dilatation slight. Arterial change general. Emphysema and pleurisy. 
Case XXXIV. May 3, 1889.—Male, age sixty-five, weight 200 pounds, muscular. Cause of 
death oedema of lungs. Kidneys, weight right 4 ounces, left 4% ounces. Cysts present. Dropsy 
present. Heart weight 13 ounces. Valvular disease, aortic, chronic. Hypertrophy none. 
Fattv metamorphosis none. Dilatation general. Arterial change (?). Pericarditis and 
emphysema. Acute alcoholism. 
Case XXXV. May 15, 1889.—Male, age fifty, weight 220 pounds, well nourished. Cause of 
death uraemia. Kidneys each 2% ounces. Cysts none. Dropsy present. Heart weight 28 
ounces. Valvular disease, aortic, chronic. Hypertrophy left ventricle. Fatty metamorphosis 
none. Dilatation left ventricle. Arterial change general. Cirrhosis of liver. Emphysema. 
Case XXXVI. May 20, 1889.—Male, age sixty-eight, weight 150 pounds, tall, emaciated. 
Cause of death cerebral apoplexy. Kidneys, weight right 4 ounces, left 5 ounces. Cysts present. 
Dropsy none. Heart weight 20% ounces. Valvular disease, aortic and mitral. Hypertrophy 
general. Fatty metamorphosis none. Dilatation general. Arterial change general! 
Case XXXVII. May 30, 1889.—Female, age fifty-seven, small, emaciated. Death sudden. 
Kidneys each 4 ounces. Cysts none. Dropsy present. Heart weight 21 ounces. Valvular 
disease, mitral, slight. Hypertrophy general. Brown atrophy. Dilatation general. Arterial 
change general. Hydropericardium, hydrothorax. Emphysema. 
Case XXXVIII. Mas' 30, 1889.—Male, age fifty-seven, fair, medium size. Cause of death 
pneumonia. Kidneys each 3 ounces. Cysts none. Dropsy present. Heart weight 16% ounces. 
Valvular disease, aortic calcification. Hypertrophy left ventricle. Fatty metamorphosis (?). 
Dilatation left ventricle. Arterial changes, aorta (?). Cirrhosis of liver. 
Case XXXIX. June 10, 1889.—Male, age thirty, weight 150 pounds, well nourished. Cause of 
death oedema of lungs. Kidneys each 3% ounces. Cysts none. Dropsy lower extremities. 
Heart weight 15 ounces. Valvular disease none. Hypertrophy left ventricle. Fatty meta- 
morphosis none. Dilatation general. Arterial change (?). Syphilitic lesions. 
Case XL. June 18,1889.—Male, age fifty-eight, weight 150 pounds, tall, emaciated, anaemic. 
Cause of death ether. Kidneys, weight right 4 ounces, left 3% ounces. Cysts present. Dropsy 
none. Heart weight 11% ounces. Valvular disease none. Hypertrophy general. Fatty meta- 
morphosis none. Dilatation slight. Arterial change (?). Pericarditis and pleurisy. 1 - 
Case XLI. June 20, 1889.—Female, age fifty-three, weight 130 pounds, well nourished. Death 
sudden. Kidneys each 3% ounces. Cysts present. Dropsy none. Heart weight 12 ounces. 
Valvular disease none. Hypertrophy slight. Fatty metamorphosis (?). Dilatation slight. 
Arterial changes (?). Gastric cancer. 
Case XLII. June 20, 1889.—Female, age fifty-two, weight 110 pounds, emaciated. Cause of 
death cedema of lungs. Kidneys each 2% ounces. Cysts none. Dropsy none. Heart weight 
15 ounces. Valvular disease none. Hypertrophy none. Fatty metamorphosis none. Dilatation 
general. Arterial changes general. Pericarditis and history of rheumatism. 
Case XLIII. June 30,1889.—Male, age twenty-six, weight 130 pounds, emaciated. Cause of 
death uraemia. Kidneys each 2% ounces. Cysts none. Dropsy none. Heart weight 23 ounces. 
Valvular disease none. Hypertrophy left ventricle. Fatty metamorphosis none. Dilatation 
general. Arterial change general, slight. History unknown. 
Case XLIV. July 1,1889.—Male, age fifty-nine, weight 135 pounds, emaciated. Cause of death 
uraemia. Kidneys each 4 ounces. Cysts none. Dropsy none. Heart weight 16 ounces. Valvular 
disease none. Hypertrophy general. Fatty metamorphosis none. Dilatation general. Arterial 
change general. Emphysema, pericarditis, and bronchiectasis. 
Case XLV. July 7, 1889.—Male, age sixty, weight 170 pounds, well nourished. Cause of death 
cedema of lungs. Kidneys, weight right 4 ounces, left 3% ounces. Cysts present. Dropsy 
present. Heart weight 15 ounces. Val vular disease none. Hypertrophy left ventricle. Fattv 
metamorphosis none. Dilatation none. Arterial change, aorta (?). Emphysema and peri- 
carditis. Hydrothorax. 
Case XLVI. July 16, 1889.—Female, age seventy-six, small, emaciated. Cause of death 
cerebral apoplexy. Kidneys each 4 ounces. Cysts none. Dropsy none. Heart weight 11 
ounces. Valvular disease, aortic and mitral, senile. Hypertrophy slight. Fatty metamorphosis 
slight. Dilatation none. Arterial change general. 
Case XLVII. August 8,1889.—Male, age fifty-three, weight 130 pounds, emaciated. Cause of 
death oedema of lungs. Kidneys, weight right 4 ounces, left 1% ounces. Cysts present. Dropsy 
present. Heart weight 13 ounces. Valvular disease, aortic, chronic. Hypertrophv slight. 
Brown atrophy. Dilatation general. Arterial changes general. Emphysema. Syphilis. 
Case XLVIII. August 15, 1889.—Female, age fifty, weight 110 pounds, small, anaemic. Cause 
of death heart failure. Kidneys each 4% ounces. Cysts none. Dropsy none. Heart weight 
14 ounces. Valvular disease none. Hypertrophy general. Brown atrophy. Dilatation general. 
Arterial changes general. Liver atrophied, icterus. 30 
FORMAL), 
Case XLIX. August 23, 1889.—Male, age thirty-eight, weight 130 pounds, emaciated. Cause 
of death uramia. Kidneys each 3 ounces. Cysts none. Dropsy none. Heart weight 12 ounces. 
Valvular disease none. Hypertrophy left ventricle. Fatty metamorphosis none. Dilatation 
none. Arterial changes (?)." Spleen 12 ounces. History of'malaria. 
Case L. August 24,1889.—Female, age seventy-six, weight 140 pounds, well nourished. Cause 
of death cerebral apoplexy. Kidneys, weight right 2% ounces, left 3% ounces. Cysts none. 
Dropsy none. Heart weight ounces. Valvular disease, senile calcification. Hypertrophy 
none. ' Brown atrophy. Dilatation general. Arterial change general. 
Series B.—Results of the Analysis of the Autopsy Records of the Philadelphia 
Hospital for Five Years, (1884-1889). 
Total number of autopsies . 1300 
Total number of typical Bright’s disease (exclusive of amyloid 
kidneys) 150 
Parenchymatous nephritis, includ- 
ing— 
Acute Bright’s disease 
Large white kidney 
Fatty and contracted, or second- 
ary contracted kidney 
cases. Chronic interstitial nephritis, in- 
cluding only— 
5 Red granular or cirrhotic kid-, 
35 ney, or primarily contracted 
(atrophic) kidney . 
35 
No. of 
cases. 
75 
Total .... 
75 Total 
75 
Males 
52 Males 
39 
Females ..... 
23 Females 
36 
Average age .... 
43 Average age .... 
59 
Acute Bright’s Disease, or Acute Parenchymatous Nephritis 
(5 Cases). 
Appearance of kidneys the same as given in the first series. 
Case I. Tyson, June 8, 1885.—Male, age thirty-two. Cause of death pneumonia. Kidneys 
one-third larger than normal. Dropsy Heart normal size. Fatty metamorphosis. Valvular 
disease, mitral regurgitation. Dilatation left side. General anasarca. 
Case II. Osier, January 23, 1888.—Male, age forty-four. Cause of death oedema of lungs. 
Kidneys equally large, swollen. Dropsy. Heart large. Hypertrophy slight. Atheroma pos- 
terior coronary artery. General anasarca. 
Case III. Henry, March 23,1888.—Male, age thirty-three. Cause of death erysipelas. Kidneys 
10 ounces each. Dropsy. Heart weight 15 ounces. Hypertrophy left side. • General anasarca. 
Acute pleurisy. 
Case IV. Musser, August 7, 1888.—Male, age thirty-five. Cause of death (edema of lungs. 
Kidneys much enlarged. Heart normal size. Slight hypertrophy. Aorta dilated. 
Case V. Neff, October 17, 1886.—Male, age fourteen. Cause of death pneumonia. Kidneys 
much enlarged. Dropsy. Heart normal. Acute hepatitis. 
Large White Kidney (35 Cases). 
Appearance of the kidneys the same as given in the first series of cases. 
Case I. Neff, August 1,1884.—Male, age forty-seven. Death sudden. Kidneys both equal 
but half larger than normal. Cysts present. Dropsy present. Heart weight 28ounces. Val- 
vular disease, aortic and mitral insufficiency. Hypertrophy general. Fatty metamorphosis 
none. Dilatation general. Atheroma none. Chronic endocarditis. HEART AND KIDNEYS IN BRIGHT’S DISEASE. 
31 
Case II. Curtin, October 4, 1884.—Male, age forty-four. Death sudden. Kidneys slightly 
enlarged equally. Cysts present. Heart normal size, but muscle ansemic. 
Case III. Parvin, February 2,1885.—Female, age eighteen. Cause of death puerperal septi- 
ctemia. Kidneys each 9% ounces. Heart slightly enlarged. Dilatation right side. No other 
lesion. 
Case IV. Hearn, September 21,1885.—Female, age thirty-two. Cause of death surgical oper- 
ation. Heart normal size. Disease of femur. 
Case V. Walker, October 1,1885.—Female, age twenty-four. Cause of death uraemia. Dropsy. 
Heart normal. 
Case VI. Tyson, December 29,1885.—Female, age thirty-one. Cause of death acute endocar- 
ditis. Kidneys, weight right 14 ounces, left 13 ounces. Dropsy. Heart enlarged. Valvular 
disease, aortic and mitral. Hypertrophy left side. Hydrothorax. No other lesions. 
Case VII. Walker, February 13, 1886. —Male, age thirty-nine. Cause of death heart failure. 
Kidneys enlarged. Dropsy. Heart large. Valvular disease, aortic and mitral insufficiency. 
' Hypertrophy general. Fatty metamorphosis. Dilatation general. Atheroma of aorta. Lung 
compressed from great hypertrophy of heart. 
Case VIII. Stryker, April 25,1886 —Female, age twenty. Cause of death uraemic coma. 
Kidneys each 10 ounces. Dropsy present. Heart weight 11 ounces. 
Case IX. Wilson, May 14,1836.—Female, age thirty-eight. Cause of death uraemia. Kidneys 
each one-third above normal. Dropsy general. Heart somewhat enlarged. Hypertrophy 
slight, general. Atheroma slight in aorta. 
Case- X. Tyson, July 8,1886.—Male, age thirty. Cause of death oedema of lungs. Kidneys 
much enlarged. Heart normal size. 
Case XI. Mills, October 17, 1886.—Male, age thirty. Cause of death pneumonia. Kidneys 
each one-third above normal. Heart large. Valvular disease, aortic. Hypertrophy left side. 
Fatty metamorphosis probably present. Dilatation left side. 
Case XII. Neff, October 27.1886.—Male, age thirty-nine. Cause of death embolic pneumonia. 
Kidneys each 11 ounces. Cysts present. Heart weight 23 ounces. Valvular disease, aortic. 
Hypertrophy general. Dilatation general. 
Case XIII. Osier, December 11, 1886.—Male, age seventy-one. Cause of death meningitis 
(purulent, basic). Kidneys each 7 ounces. Cysts innumerable. Heart medium size. Valvular 
disease, mitral and aortic. Brown atrophy. "Atheroma, aorta, and places in coronary. 
Case XIV. Neff, January 1, 1887.—Female, age sixteen. Cause of death asdema of lungs. 
Kidneys much enlarged. Dropsy. Heart normal. 
Case XV. Bruen, April 11, 1887.—Male, age thirty-three. Cause of death oedema of lungs. 
Kidneys enlarged. Dropsy. Heart weight 32 ounces. Valvular disease, mitral regurgitation. 
Hypertrophy general. Dilatation general. 
Case XVI. Bruen, June 11, 1887.—Male, age thirty-four. Cause of death oedema of lungs. 
Kidneys above normal. Dropsy. Heart large. Hypertrophy general. 
Case XVII. Tyson, July 26, 1887.—Male, age seventy. Cause of death congestion of lungs. 
Kidneys large, unequal. Dropsy. Heart large. Valvular disease, aortic and mitral. Hyper- 
trophy general. Fatty metamorphosis present. Atheroma of aorta and coronary. Large 
rignt inguinal hernia. 
Case XVIII. Walker, July 13,1887.—Male, age twenty-six. Cause of death phthisis. Kidneys 
each 10 ounces. Heart normal. 
Case XIX. Wilson, July 22, 1387. — Female, age thirty-three. Cause of death uraemia. 
Kidneys equally enlarged. Heart normal in size. Valvular disease, mitral stenosis. 
Case XX. Musser, August 16, 1887.—Male, age thirty-seven. Cause of death uraemia. 
Kidneys each 8 ounces. Dropsy. Heart weight 11 ounces. Hypertrophy general. Pericar- 
ditis. 
Case XXI. Musser, October 12, 1887.—Male, age thirty-six. Cause of death heart failure. 
Kidneys equally large. Dropsy. Heart weight 9)4 ounces. Hypertrophy left side. Atheroma, 
aorta. 
Case XXII. Musser, January 23, 1888.—Male, age fifty. Cause of death uraemia. Kidneys 
equally large. Dropsy. Heart normal size. Hypertrophy left side. Fatty metamorphosis 
probably present. Dilatation right ventricle. 
Case XXIII. Walker, June 5,1838.—Male, age fifty-two. Cause of death uraemia. Kidneys 
equally large. Heart slight hypertrophy, llydrothorax. 
Case XXIV. Parish, June 22, 1888.—Female, age thirty-two. Cause of death septicaemia. 
Kidneys, weight right 11)4 ounces, left 13 ounces. Miliary septic abscesses. Heart normal. 
Cystitis, septic abscess. 
Case XXV. Musser. August 7,1888.—Male, age twenty-seven. Cause of death oedema of lungs. 
Kidneys each 18 ounces. Heart normal. 
Case XXVI. Dercum, March 3, 1889.—Female, age fifty-seven. Cause of death septicaemia 
from bedsores. Kidneys equally enlarged. Cysts. Heart normal size. Valvular disease, 
mitral. Atheroma of aorta and coronary. Hemorrhagic infarct of kidney. 
Case XXVII. Henry, June 15, 1889.—Female, age forty-five. Cause of death cerebellar 
glioma. Kidneys equally enlarged. Heart weight 12 ounces. Valvular disease, aortic, slight. 
Hypertrophy present. 32 
FORMA D, 
Case XXVIII. Walker, April 20,1889.—Male, age sixty. Cause of death pneumonia. Kidneys 
equally enlarged. Heart large. Valvular disease, aortic. Hypertrophy general. Dilatation 
general. 
Case XXIX. Walker, July 11,1889.—Male, age forty. Cause of death pericarditis. Kidneys 
equally enlarged. Heart large. Valvular disease, aortic and mitral. Hypertrophy general. 
Atheroma of aorta. 
Case XXX. Tyson, July 23,1889.—Female, age sixty. Cause of death unemia. Kidneys each 
6 ounces. Dropsy. Heart weight 22 ounces. Valvular disease, mitral. Hypertrophy left side. 
Dilatation left side. Atheroma of aorta. 
Case XXXI. Wilson, July 24,1889.—Male, age thirty-two. Cause of death uraemia. Kidneys 
each 6)4 ounces. Heart weight 9 ounces. Lungs, chronic phthisis. 
Case XXXII. Tyson, July 24,1889.—Male, age thirty. Cause of death abdominal tuberculosis. 
Kidneys each 6)4 ounces. Dropsy. Heart weight 9)4 ounces. Hypertrophy slight, general. 
Miliary tuberculosis. 
Case XXXIII. Martin, July 29, 1889.—Male, age forty-four. Cause of death apoplexy, menin- 
gitis. Kidneys each 7)4 ounces. Heart weight 14 ounces. Valvular disease, aortic and mitral, 
acute. Hypertrophy general. 
Case XXXIV. Henry, July 31, 1889.—Male, age forty-four. Cause of death acute phthisis. 
Kidneys each 10 ounces. Heart weight 10 ounces. ’ Hypertrophy general. Slight general 
atheroma. 
Case XXXV. Curtin, August 10,1889.—Male, age seventeen. Cause of death typhoid fever. 
Kidneys each 5)4 ounces. Heart weight 11 ounces. Hypertrophy general. Scrofulous. 
Fatty and Contracted Kidney (35 Cases). 
Appearance of the kidneys the same as in the first series. 
Case I. Tyson, April 3, 1884.—Male, age fifty-five. Cause of death uraemia. Kidneys, weight 
right 4 ounces, left 4% ounces. Large cysts in both. Dropsy. Heart large. Hypertrophy 
general. Atheroma of aorta. Evidence of subacute attack. 
Case II. Walker, May 3. 1884.—Female, age twenty-two. Cause of death uraemia. Kidneys, 
weight right 3 ounces, left 5)4 ounces. Large cyst in left kidney. Heart normal. 
Case III. Tyson, August 13, 1884.—Female, age forty. Cause of death pyelitis and inanition. 
Kidneys above normal. Heart normal. Complete prolapsus uteri. Pyelitis. 
Case IV. Neff, August 25,1884.—Male, age forty. Cause of death oedema of lungs. Kidneys, 
left very large, right smaller. Dropsy. Heart large. Valvular disease, mitral. Hypertrophy 
left ventricle. Atheroma of aorta. 
Case V. Curtin, November 3, 1884.—Male, age thirty-eight. Cause of death heart failure. 
Kidneys equally enlarged. Heart large. Valvular disease, aortic thickening. Hypertrophy 
slight. 
Case VI. Curtin, January 24, 1885.—Male, age forty-three. Cause of death pneumonia. 
Kidneys each 5% ounces. Heart normal. 
Case VII. Tyson, May 11, 1885.—Male, age sixty-eight. Cause of death pulmonary (edema. 
Kidneys, weight right 4 ounces, left 4)4 ounces. Cysts in right kidney. Heart weight 16 
ounces. Valvular disease, mitral. Hypertrophy general. Atheroma of aorta. 
Case VIII. Wilson, May 19,1885.—Male, age fifty-five. Cause of death pneumonia. Kidneys 
unequally enlarged. Heart normal. 
Case IX. Bruen, August 8.1885.—Female, age fifty. Cause of death pneumonia. Kidneys 
above normal, both equal. Cysts. Dropsy. Heart large. Hypertrophy slight, general. Dila- 
tation. Atheroma of aorta. 
Case X. Walker, September 17,1885.—Male, age nineteen. Cause of death pulmonary oedema. 
Kidneys below normal, equal. Dropsy. Heart large. Hypertrophy slight. Dilatation right 
ventricle. 
Case XI. White, November 2, 1885.—Male, age sixty-six. Cause of death septicaemia. 
Kidneys below normal. Heart normal. Operation for injury of foot. 
Case XII. Wood, December 9, 1885.—Male, age fifty. Cause of death cerebral apoplexy. 
Kidneys below normal. Heart enlarged. Valvular disease, aortic valves thickened. Hyper- 
trophy right ventricle slight. Atheroma of aorta and cerebral. 
Case XIII. Walker, March 4, 1886.—Male, age forty-five. Cause of death heart failure. 
Kidneys below normal. Dropsy. Heart weight 28 ounces. Valvular disease, aortic, chiefly 
endocarditis. Hypertrophy general. Fatty metamorphosis. Dilatation general. Endocar- 
ditis and pericarditis, chronic. 
Case XIV. Wood, April 8, 1886.—Female, age sixty-four. Cause of death uraemia. Kidneys 
below normal. Heart normal size. Fatty metamorphosis. Dilatation slight, general. 
Case XV. Walker, June 19, 1886.—Male, age sixty-one. Cause of death oedema of lungs. 
Kidneys above normal. Heart enlarged. Fatty metamorphosis. Dilatation general and well 
marked. Thickness of left ventricle much diminished. 
Case XVI. Osier, December 19, 1886.—Male, age fifty. Cause of death uraemia. Kidneys 
below normal in size. Cyst with calculus size of a large pea. Heart normal size. Hypertrophy- 
slight. HEART AND KIDNEYS IN BRIGHT’S DISEASE. 
33 
Case XVII. Janney, January 26, 1887.—Male, age thirty-four. Cause of death heart failure. 
Kidneys below normal. Heart weight 24 ounces. Hypertrophy general. Atheroma of aorta 
and renal. 
Case XVIII. Wilson, March 12,1887.—Male, age fifty-two. Cause of death phthisis. Kidneys 
slightly below normal. Heart weight 9 ounces. 
Case XIX. Tyson, April 11, 1887.—Male, age seventy-two. Cause of death heart failure. 
Kidneys slightly below normal. Heart, old endocarditis. Fatty metamorphosis. Dilatation 
general. 
Case XX. Wilson, May 17,1887.—Female, age thirty-eight. Cause of death uraemia. Kidneys, 
left small, right normal. Cyst. Heart small. 
Case XXI. Bruen, June 10,1887.—Male, age seventy-four. Cause of death asthenia. Kidneys 
normal in size, Cyst. Dropsy. Heart large. Valvular disease, aortic and mitral. Hyper- 
trophy general. Atheroma of aorta and coronary, complicated by gastric ulcer. 
Case XXII. Bruen, August 9, 1887.—Male, age fifty-four. Cause of death uraemia. Kidneys 
equally enlarged. Dropsy. Heart weight 14 ounces. Hypertrophy general. Dilatation general. 
Atheroma, aorta. 
Case XXIII. Musser, October 24, 1888.—Male, age thirty. Cause of death uraemia. Kidneys 
enlarged. Heart small. 
Case XXIV. Musser, October 29, 1888.—Male, age fifty-eight. Cause of* death uraemia. 
Kidneys enlarged. Dropsy. Heart weight 20 ounces. Valvular disease, mitral. Hypertrophy 
general. Fatty metamorphosis. Dilatation left auricle. Atheroma, aorta. 
Case XXV. Musser, October 18, 1888.—Male, age sixty-five. Cause of death emphysema. 
Kidneys enlarged. Heart small. Valvular disease, aortic and mitral. Atheroma, aorta. 
Papillary muscles of left ventricle fibroid. 
Case XXVI. Curtin, December 13, 1888.—Female, age thirty-five. Cause of death uraemic 
convulsions. Kidneys enlarged, right larger. Cysts and dropsy. Heart medium size, mitral 
stenosis. Hypertrophy slight. Fatty metamorphosis. Dilatation general. History of rheuma- 
tism. Renal arteries thick and stiff. 
Case XXVII. Curtin, January 21, 1889.—Male, age sixty-nine. Cause of death alcoholism. 
Kidneys large. Heart large. Valvular disease, mitral. Hypertrophy general. Atheroma, 
aorta and coronary. Alcoholism. Chronic gastritis. Emphysema, hydrothorax. 
Case XXVIII. Osier, January 25, 1889.—Female, age seventy-five. Cause of death hydro- 
thorax. Kidneys enlarged, left larger. Cysts and dropsy. Heart small. Valvular disease, 
mitral. Dilatation right side. Atheroma, aorta (dilated also). 
Case XXIX. Bruen, February 5, 1889.—Male, age fortv-three. Cause of death uraemia. 
Kidneys enlarged. Heart large. Valvular disease, mitral stenosis. Hypertrophy left side. 
Dilatation left side. 
Case XXX. Bruen, March 3,1889.—Female, age fifty. Cause of death heart failure. Kidneys 
about normal. Heart small. Valvular disease, mitral. Fatty metamorphosis. Dilatation 
general. Emphysema, hydrothorax. 
Case XXXI. Steinbach, June 10, 1889.—Female, age thirty-four. Cause of death embolic 
pneumonia. Kidneys equally enlarged. Heart normal in size. Valvular disease, aortic and 
mitral. Died after a surgical operation. 
Case XXXII. Walker, April 19, 1889.—Female, age eighty-seven. Cause of death senility. 
Kidneys normal size. Cyst and dropsy. Heart medium size. Valvular disease, mitral valve 
thickened. Dilatation general. Atheroma, aorta and coronaries. Senile change (?). 
Case XXXIII. Tyson, July 13, 1889.—Female, age thirty-eight. Cause of death carcinoma of 
pylorus. Kidneys normal size. Heart small. Fatty metamorphosis (?). Atheroma, coronary. 
Case XXXIV. Lloyd, August 18,1889.—Male, age seventy-seven. Cause of death uraemia. 
Kidneys each 6 ounces. Dropsy. Heart weight 20 ounces. Hypertrophy general. Fatty 
metamorphosis. Dilatation general. Chronic obliterating pericarditis. Hydrothorax. 
Case XXXV. Curtin, August 12, 1889.—Male, age forty-nine. Cause of death phthisis. 
Kidneys equally enlarged. Dropsy. Heart large. Hypertrophy general. 
Red Granular Kidneys (75 Cases). 
Appearance of the kidneys the same as in the first series. 
Case I. Wilson, May 24,18S4.—Male, age forty-six. Cause of death uraemia. Cysts not stated. 
Dropsy none. Heart weight 17 ounces. Valvular disease none. Hypertrophy simple. No 
other lesions. 
Case II. Bruen, May 28, 1884.—Male, age thirty-two. Cause of death uraemic coma. No 
cysts. No dropsy. Heart enlarged. Valvular disease none. Hypertrophy left side. Dilataj 
tion left ventricle. No other lesion. 
Case III. Walker, October 7, 1884. — Male, age forty-one. Cause of death tubercular peri- 
tonitis. No cysts. Ascites. Heart normal. No other lesion. 
Case IV. Walker, October 6.1884.—Male, age forty-nine. Cause erf death uraemia. No cysts. 
Dropsy present. Heart enlarged. Hypertrophy simple. No other lesion. 34 
FORM AD, 
Case V. Tyson, August 28, 1884.—Female, age forty. Cause of death uraemia. No cysts. 
Dropsy present. Heart weight 28 ounces. Valvular disease, mitral stenosis. Hypertrophy 
general. Dilatation right ventricle. Atheroma, aorta. Much pericardial effusion. 
Case VI. Bruen, October 6,1884.—Male, age forty-eight. Cause of death uraemia. Cysts absent. 
No dropsy. Heart enlarged. Valvular disease, aortic. Hypertrophy left-sided. ’ Dilatation 
general. Atheroma, aorta. 
Case VII. Neff, October 9, 1884.—Male, age forty-nine. Cause of death oedema of lungs. No 
cyst. Dropsy present. Heart much enlarged. Valvular disease, aortic stenosis, and regur- 
gitation. Hypertrophy left side. Dilatation left ventricle. Atheroma, aorta. Dilatation of 
arch of aorta. 
Case VIII. Bruen, November 15,1884.—Male, age sixty-one. Cause of death uraemia. Cysts 
present. Dropsy present. Heart much enlarged. Valvular disease none. Hypertrophy gen- 
eral. Left ventricle one inch thick. Dilatation general. Unilateral pleural effusion. 
Case IX. Porter, December 16, 1884.—Male, age twenty-two. Cause of death phthisis. No 
cysts. No dropsy. Heart small. No other lesion. Kidney somewhat translucent. 
Case X. Curtin, December 18, 1884.—Male, age forty-three. Cause of death uraemia. No 
cysts. Dropsy present. Heart large. Hypertrophy general. Dilatation both sides. No other 
lesion. History of syphilis. 
Case XI. Mills, January 15, 1885.—Male, age fifty-two. Cause of death uraemic coma. No 
cysts. ' No dropsy. Heart normal. No other lesion. 
Case XII. Wood, February 18,1885.—Female, age twenty-seven. Cause of death congestion 
of lungs. No cyst. No dropsy. Heart normal. No other lesion. Epileptic. 
Case XIII. Wood, February 24,1885.—Male, age seventy-five. Cause of death oedema of lungs. 
Cysts and dropsy present. Heart large. Valvular disease, mitral. Hypertrophy general. Dila- 
tation general. Atheroma, aorta and coronary. Chronic endocarditis. 
Case XIV. Wilson, April 11, 1885.—Female, age twenty-eight. Cause of death pneumonia. 
Cysts none. Dropsy present. Heart large. Valvular disease, mitral. Hypertrophy general. 
Dilatation general. Atheroma, aorta. Pericarditis adhesive and with calcification. 
Case XV. Bruen, May 17,1885.—Male, age fifty. Cause of death pneumonia. Cysts present 
Dropsy present. Heart twice normal size. Valvular disease, mitral. Hypertrophy general. 
Muscles flabby. Dilatation general. Chronic endocarditis. 
Case XVI. Bruen, May 2,1885.—Male, age forty-seven. Cause of death cedema of lungs. No 
cysts nor dropsy. Heart normal size. Valvular disease, aortic. Hypertrophy none. Fatty 
metamorphosis present. Dilatation none. Atheroma, aorta and coronary. 
Case XVII. Bruen, June 9,1885.—Male, age seventy. Cause of death apoplexy. Cysts present. 
Dropsy none. Heart normal. Fatty metamorphosis principally on leftside. Dilatation general. 
Atheroma: coronary, cerebral, and aorta. Chronic pleurisy. 
Case XVIII. Curtin, July 12, 1885.—Female, age forty-four. Cause of death asthenia. NO 
cyst. No dropsy. Heart normal size. Valvular disease, slight, mitral. Fatty metamorphosis 
present. Dilatation. 
Case XIX. Walker, September 12,1885.—Male, age seventy. Cause of death meningitis. No 
dropsy. No cysts. Heart enlarged. Valvular disease, mitral. Fatty metamorphosis present. 
Dilatation general. Atheroma present, especially coronary. 
Case XX. Curtin, October 27, 1885.—Female, age forty. Cause of death exhaustion due to 
cystitis. No cysts nor dropsy. Heart normal size, Valvular disease none. Hypertrophy none. 
Fatty metamorphosis present. Muscles flabby and tough. Cystitis and renal calculi. 
Case XXI. Curtin, November 21.1885.—Male, age seventy-three. Cause of death oedema of 
lungs. No cysts. Dropsy present. Heart large. Valvular disease, aortic and mitral. Hyper- 
trophy left side. Fatty metamorphosis none. No atheroma. Acute pericarditis. History of 
syphilis. 
Case XXII. Bruen, June 29,1886.—Female, age seventy. Cause of death pericarditis. No 
cyst. No dropsy. Heart normal. Valvular disease, aortic valves thickened. Hypertrophy 
none. Fatty metamorphosis present. No atheroma. Mediastinal sarcoma. Pericarditis. 
Case XXIII. Neff, August 29, 1886.—Male, age eighty-five. Cause of death uraemia. Cysts 
present. No dropsy. Heart large. Valvular disease, aortic calcification. Hypertrophy general. 
Atheroma, aorta. 
Case XXIV. Neff, October 13,1886.—Female, age fifty-seven. Cause of death uraemia. Cysts 
none. Dropsy none. Heart normal size. Valvular disease, mitral. Hypertrophy none. Fatty 
metamorphosis present. Hemorrhagic infarct in kidney. 
Case XXV. Musser, August 31, 1886.—Female, age thirty-six. Cause of death heart failure. 
No cysts. Dropsy present. Heart weight 17 ounces. Valvular disease, mitral. Hypertrophy 
general. Atheroma, coronaries. 
Case XXVI. Mills, October 14, 1886.—Female, age seventy-eight. Cause of death sclerosis of 
brain. Cysts present. No dropsy. Heart enlarged. Valvular disease none. Hypertrophy 
general. 
Case XXVII. Mills, January 16,1887.—Female, age sixty-five. Cause of death uraemia. No 
cysts. No dropsy. Heart normal size. Valvular disease none. Hypertrophy none. 
/Case XXVIII. Walker, February 18,1887.—Male, age fifty-eight. Cause of death uraemia. No 
cysts. No dropsy. Heart enlarged. Valvular disease none. Hypertrophy left side. Dilatation 
right ventricle. * Atheroma, aorta. HEART AND KIDNEYS IN BRIGHT’S DISEASE. 
35 
Case XXIX. Wilson, February 26,1887.—Male, age fifty-one. Cause of death oedema of lungs. 
Cysts present. No dropsy. Heart weight 18 ounces. Valvular disease none. Hypertrophy 
left side. Dilatation left ventricle. Atheroma, aorta. 
Case XXX. Tyson, April 11,1887.—Female, age seventy. Cause of death uraemia. No cysts. 
No dropsy. Heart weight 14 ounces. Valvular disease none. Hypertrophy general. Arterial 
change, aortic. History of syphilis. 
Case XXXI. Wilson, May 3,1887.—Male, age fifty-two. Cause of death oedema of brain. No 
cyst. Dropsy present. Heart normal size. Valvular disease, aortic. Fatty metamorphosis 
present. Arterial changes, coronary and aorta. 
Case XXXII. Tyson, June 20,1887.—Female, age fifty. Cause of death apoplexy. No cyst. 
No dropsy. Heart enlarged. Valvular disease, mitral. Hypertrophy general. Arterial changes, 
aorta and cerebral. Heart had moderator band. 
Case XXXIII. Ransley, June 27, 1887.—Female, age forty-one. Cause of death heart failure. 
Cysts present. Dropsy absent. Heart small. Valvular disease, mitral. Fatty metamorphosis 
present. Dilatation present. 
Case XXXIV. Tyson, August 20,1887.—Male, age sixty-five. Cause of death uraemia. Cysts 
present. Dropsy present. Heart small. Valvular disease, aortic and mitral. Fatty meta- 
morphosis present. Dilatation present. Arterial changes, aorta and coronary. 
Case XXXV. Mills, September 1, 1887.—Female, age ninety-six. Cause of death senility. 
Cysts present. Dropsy absent. Heart small. Valvular disease, aortic and mitral. Fatty 
metamorphosis present. Arterial change, aorta. 
Case XXXVI. Dercum, October 22, 1887.—Male, age eighty-two. Cause of death uraemia. 
Cysts absent. Dropsy absent. Heart normal size. Fatty metamorphosis present. Arterial 
change, aorta and coronary. 
Case XXXVII. Dercum, November 19,1887.—Male, age fifty-four. Cause of death oedema of 
brain. Cysts and dropsy both absent. Heart enlarged. Valvular disease, mitral. Hyper- 
trophy left side. 
Case XXXVIII. Dercum, November 27,1887.—Female, age eighty. Cause of death oedema 
of brain. Cysts absent. Dropsy present. Heart enlarged. Valvular disease, mitral and aortic. 
Hyjiertrophy general. Arterial changes, aorta. Aneurism of abdominal aorta. 
Case XXXIX. Parish. December 25, 1887.—Female, age forty. Death sudden. Cysts and 
dropsy both absent. Heart small. Fatty metamorphosis present. Dilatation present. History 
of syphilis. 
Case XL. Osier, January 25, 1888.—Female, age fifty-six: Cause of death uraemia. Cysts 
present. Dropsy absent. Heart large. Valvular disease, mitral. Hypertrophy left side. 
Pleural effusion. 
Case XLI. Henry, March 30,1888.—Female, age seventy. Cause of death heart failure. Cysts 
none. Dropsy none. Heart weight 18 ounces. Valvular disease, aortic and mitral. Hyper- 
trophy general. Arterial changes, aorta and coronary. Patulous foramen ovale and endo- 
carditis. 
Case XLII. Walker, April 28, 1888.—Male, age sixty-eight. Death sudden. Cysts present. 
Dropsy present. Heart weight 31 ounces. Valvular disease, aortic. Hypertrophy left side one 
and a quarter inch in front. Chronic adhesive pericarditis. 
Case XLIII. Walker, May 4,1888.—Female, age sixty-eight. Cause of death uraemia. Cysts 
absent. Dropsy present. Heart weight 14 ounces. Hypertrophy right side. Arterial change, 
aorta and coronary. 
Case XLIV. Dercum, August 12,1888.—Male, age fifty-two. Cause of death senile gangrene. 
Cysts absent. Dropsy absent. Heart normal size. Valvular disease, aortic and mitral. Hyper- 
trophy left side. Arterial changes, aortic and coronary. Heart firmly contracted. 
Case XLV. Deaver, August 21,1888.—Female, age forty-one. Cause of death uraemia. Cysts 
none. Dropsy none. Heart normal size. 
Case XLVI. Musser, September 21, 1888.—Female, age forty-six. Cause of death uraemia. 
Cysts present. Dropsy absent. Heart normal size. Valvular disease, mitral. Hypertrophy 
slight and general. Arterial changes, coronary. 
Case XLVII. Osier, September 10,1888.—Male, age forty-seven. Cause of death uraemia. No 
cysts nor dropsy. Heart large. Hypertrophy present, right ventricle larger than left. Arterial 
changes, aorta and coronary. Small renal arteries greatly enlarged. 
Case XLVIII. Mills, October 9,1888.—Male, age sixty. Cause of death uraemia. Cysts present. 
Dropsy absent. Heart large. Valvular disease, mitral and aortic. Hypertrophy left side. 
Dilatation left side. 
Case XLIX. Dercum, October 12, 1888.—Male, sixty-three. Cause of death pneumonia or 
uraemia. Cysts present in both. Dropsy absent. Heart normal. Valvular disease, aortic, 
chronic. Fatty metamorphosis present. Atheroma, aorta. Pneumonia. 
Case L. Musser, October, 12,1888.—Female, age ninety-one. Cause of death abdominal aneu- 
rism. Cysts present in both kidneys. Dropsy absent. Heart large. Valvular disease, aortic, 
chronic. Hypertrophy left side. Atheroma, aortic and general. Large abdominal aneurism. 
Renal arteries also atheromatous, papillary muscles fibroid change. 
Case LI. Mills, October 15, 1888.—Male, age sixty-five. Cause of death pachymeningitis 
hemorrhagica. Cyst present in both kidneys. Dropsy absent. Heart large. Valvular disease, 
mitral, chronic. Hypertrophy general. Atheroma, aorta and coronary. 36 
HEART AND KIDNEYS IN BRIGHT’S DISEASE. 
Case LII. Bruen, November 20,1888.—Male, age seventy-eight. Cause of death pulmonary 
oedema. Cysts present. Dropsy present. Heart normal size. Valvular disease, aortic regurgi- 
tation. Atheroma: aorta, internal carotid, basilar, and coronary. Aortic valves fenestrated 
and hydronephrosis. 
Case LIII. Dercum, October, 20,1888.—Female, age seventy-six. Cause of death apoplexy. 
No cysts. No dropsy. Heart small. Valvular disease, aortic. Fatty metamorphosis present. 
Atheroma, aorta and arteries of brain. 
Case LIV. Curtin, October 31, 1888.—Female, age sixty-five. Cause of death pulmonary 
cedema. Cysts present. Dropsy absent. Heart enlarged. Valvular disease, mitral. Hyper- 
trophy left side. Dilatation right ventricle. Atheroma, aorta. 
Case LV. Musser, November 21,1888.—Female, age sixty-eight. Cause of death uraemia. 
Cysts and dropsy both absent. Heart large. Valvular disease, mitral. Hypertrophy left side. 
Atheroma, aorta and coronary. 
Case LVI. Dercum, December 1,1888.—Female, age seventy-three. Cause of death pneumonia. 
Cysts present. Dropsy present. Heart large. Hypertrophy left side. Atheroma, aorta and 
cerebral arteries. Cirrhosis of liver. 
Case LVII. Dercum, December 30, 1888.—Male, age fifty-six. Cause of death uraemic convul- 
sion. Cysts present. Dropsy present. Heart large. Valvular disease, mitral. Hypertrophy 
general. Fatty metamorphosis present. Dilatation general. Atheroma, aorta and cerebral. 
Case LVIII. Mills, December 18.1886.—Female, age seventy-two. Cause of death meningitis. 
Cyst absent. Dropsy absent. Heart normal size. Valvular disease, aortic and mitral. Hyper- 
trophy none. Fatty metamorphosis. Dilatetion marked. 
Case LIX. Musser, December 29, 1886.—Female, age fifty-five. Cause of death pneumonia 
and ursemia. Cyst and dropsy absent. Heart weight 11 ounces. Valvular disease none. 
Hypertrophy general. Fatty metamorphosis none. Dilatation right ventricle. Atheroma, 
aorta and coronaries. 
Case LX. Neff, December 30,1886.—Female, age :thirty-five, highly anaemic. Cause of death 
uraemia. No cysts. No dropsy. Heart normal size. No other lesion. History of malaria. 
Case LXI. Henry, February 20, 1889.—Male, age forty-eight. Cause of death uraemia and 
pneumonia. Heart weight 10 ounces. Valvular disease and dropsy none. Hypertrophy slight. 
Case LXII. Montgomery, March 5, 1889.—Female, age sixty. Cause of death uraemia. Heart 
large. Valvular disease none. Hypertrophy left-sided. Dilatation right-sided. Ovariotomy. 
Case LXHI. Walker, March 29, 1889.—Female, age ninety. Cause of death heart failure. 
Many cysts. Dropsy present. Heait large. Valvular disease, aortic and mitral. Fatty meta- 
morphosis present.' Dilatation general. Atheroma, aorta and coronaries. 
Case-LXIV. Tyson, April 19,1889.—Male, age sixty. Cause of death pleural effusion. Dropsy 
present. Heart normal size. Displaced by right-side pleural effusion. 
Case LX V. Walker, April 18,1889.—Female, age seventy-nine. Cause of death phthisis. Heart 
normal. Valvular disease, aortic. Hypertrophy slight. Dilatation slight. Heart and kidney 
changes may be senile. 
Case LXVI. Wilson, May 3,1889.—Male, age sixty-three. Cause of death heart failure. Cysts 
present. Dropsy absent. Heart weight 20 ounces. Valvular disease, aortic. Hypertrophy left- 
sided one inch.' Fatty metamorphosis none. Dilatation general. Atheroma, aorta and cerebral. 
Case LXVII. Henry, .Tune 11,1889.—Male, seventy-six. Cause of death emphysema. Dropsy 
present Heart weight 18 ounces. Valvular disease, slight thickening. Hypertrophy general. 
Case LXVIII. Henry, June 15,1889.—Female, age eighty-four. Cause of death senility. Cysts 
present. Dropsy absent Heart weight 9 ounces. Valvular disease none. Hypertrophy slight. 
Atheroma, aorta and coronaries. 
Case LXIX. Lloyd, June 26, 1889.—Male, age sixty-nine. Death sudden. Heart weight 24 
ounces. Valvular disease none. Hypertrophy general. Atheroma, basilar arteries. 
Case LXX. Henry, July 11, 1889.—Male, age fifty-five. Cause of death ursemia. Heart very 
.arge. Valvular disease none. Hypertrophy left side. 
Case LX XI. Walker, July 15,1889.—Female, age seventy-one. Cause of death phthisis. Cysts 
present. Heart small. Valvular disease, aortic. Atheroma, coronaries. 
Case LXXII. Walker, July 17, 1889.—Female, age eighty. Cause of death uraemia. Cysts 
none. Dropsy present. Heart weight 22 ounces. Valvular disease, mitral insufficiency. 
Hypertrophy general, left ventricular one and a quarter inch, right three-quarters of an inch. 
Atheroma none. 
Case LXXIII. Lloyd, July 22, 1889.—Male, age forty-nine. Cause of death apoplexy. Heart 
weight 20 ounces. Valvular disease, aortic. Hypertrophy left side. Dilatation left side. 
Case LXXIV. Dercum, July 27, 1889.—Male, age forty-nine. Cause of death meningitis. 
Heart weight 11 ounces. Valvular disease, mitral. Hypertrophy slight. Atheroma, root of 
aorta. Contraction of kidney, slight, cyanotic. 
Case LXXV. Dercum, August 1, 1889.—Female, age fifty-three. Cause of death cerebral 
apoplexy. Heart normal size. Valvular disease, mitral, slight. Atheroma : aorta, coronaries, 
and cerebral.