quickly obtained. The liability of vascular rupture and extravasation constitutes the chief danger. The recovery may be complete, but the necessity of careful regulation of the diet and regimen, with a view to prophylaxis, is imperative.The congestive form of apoplexy is distinguished from the hoemorrhagic and embolie forms by the distinctive group of symptoms connected with the seizure, and by the absence of the romaining-over symptoms, hemiplegia, aphasia, aud impairment of mind. It is separated from the uraemic form by the absence of albumen and tube-casts from the urine, and its freedom, as a rule, from the convulsions so common in uraemia. The differential diagnosis from alcoholic coma would be helped by the exclusion, both from history and environment, of everything suggestive of alcohol.IV.THE UltJEMIO FORM.The anatomical basis in this affection is the contracted kidney, or the kidney of diffuse chronic nephritis. The essential pathological condition is toxaemiaThere is an accumulation in the blood, and also probably in the tissues, of urea, or at least of some one, or more, of the excrementitious products of tissue-metabolism, of which urea represents the final stage, which are normally thrown off in the urine. The coma of uraemia is sometimes gradually developed, without sudden attack. In other casos coma occurs with apoplectic suddenness. It is only with the hitter class of cases that we are now concerned.These may be prodromic phenomena, such as headache, dizziness, dyspnoea, dyspepsia, oedema, or a fleeting sensation, as if about to faint. But the seizure is abrupt, with marked shock. A man of early or middle mature life, of pale complexion, and contrasting in physique with a subject of congestive apoplexy, who has never thought of himself, or been regarded by his friends ¡is a sick man, is suddenly stricken down.Later, in retrospect, friends may be able to recall little circumstances indicative of slight impairment of vigor and elasticity of mind or body, which did not at the time arrest their attention. The coma is profound. The face is pale, and often covered with cold sweat. There is stertorous breathing, aud the pupils are dilated.In the great majority of cases the coma is preceded by, or accompanied with, convulsions. These are epileptiform in character, with frothing at the mouth, and biting of the tongue. The convulsions may be repeated at longer or shorter intervals, and death may occur within two or three days, with no recovery of consciousness ; or, the coma being less profound, consciousness may be recovered, and weeks or months may elapse before the occurrence of the final and fatal seizure. During this interval the characteristic anaemia of chronic Bright's disease may become rapidly developed.Hemiplegia and other symptoms, which characterize cerebral extravasation aud embolism, are usually absent. So also are the peculiar physique, the flushed face, the injected eyes, the contracted pupils, the full, bounding pulse, and the other characteristic symptoms of active cerebral congestion. Th...
