Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

136/440 (page 120)

otlier cliaracteristics; that is to say, it remains cloudy, cott- tains more or less blood and much albumen, and deposits a. copious precipitate of formed elements. Possibly this is to be explained by the fact that the inflammatory processes in the kidney still continue, whereas the condition of the skin becomes improved. The increase in the quantity of urine, which occurs at a certain stage in this form of chronic nephritis, might con- sequently be regarded as due to the absorption of the dropsical effusion ; but the converse could not be assumed, viz. that the disappearance of the latter is due to increased diuresis. This latter process takes place when the form of disease has its starting point in ('^ secondary atrophy, which is induced when the development of the fibrillary connective tissue pre- ponderates. The conditions in that case more and more approximate to those of the primary or genuine cirrhosis of the kidney. In this last-named condition it is not the abnormal permea- bility of the tissue and of the vessels in particular which is the determining factor, but the increased arterial pressure. We may not assume that the vessels embedded in the close meshes of a fibrous connective tissue, and themselves for the most part thickened and indurated, are to an abnormal extent permeable by albumen; and such a view is also decidedly contravened by the state of cicatricial connective tissue in other parts, e.g. the skin, when dropsical effusion exists. The small and the varying amount of albumen found in the urine in cases of renal cirrhosis must, therefore, in my opinion, be referred to the coexistence of small inflamma- tory areas, the predominance of which is a feature of the former type, but which ai'e not altogether wanting in the disease in question. In cases in which these are absent, or no longer active, the albuminuria, that is, the manifest excretion of albumen, will disappear, and the more so because the quantity of urine will be simultaneously increased and its percentage of albumen consequently still further reduced. It is universally admitted that the increase in the quantity of urine is the result of the enormous increase of pressure, which must occur in the vessels which are still pervious, in consequence of the wide-spread destruction of these pai'ts and the co-existent cardiac hypertrophy. I regard it also as