Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

126/440 (page 110)

tion of a patient suffering from fever exactly resembles that of an animal artificially heated, so long as the increase in tlie bodily temperature does not exceed certain limits and does not exercise a paralysing effect upon the nervous apparatus (see page 47). The diminution also in the quantity of urine is as common in fevers, and for reasons that are well known, as in cases where the temperature is artificially raised, so that those instances of febrile albuminui-ia which present themselves, accompanied by a properly maintained action of the heart, a strong pulse, &c., may, without any hesitation, be classed together with that form which is induced by the artificial ap- plication of heat. The elevation of the bodily temperature is the essential, if not the only condition for the production of the albuminuria, the immediate origin of which has been explained in previous pages. The conditions may be entirely different in the subsequent course of a fever, or in cases of severe infection or poisoning, or even at the commencement of a fever in a person already debilitated. In these oases, no doubt, the blood-pressure will fall below the normal degree. And therein, as we have seen when discussing the influence of diminished pressure, may be discovered a condi- tion for the production of albuminuria, but one which will probably be insufficient jper se for such a purpose, inasmuch as the pressure is not usually reduced to a considerable extent. But there are other factors of various kinds which act in the same direction, and whose influence is greater in severe febrile conditions accompanied by decreasing cardiac activity than in others; among these a prominent place may be assigned to derangements of the nutrition of the renal epithelium and possibly also of the walls of the vessels. We know that such derangements occur, and that their intensity varies with the disease which originates them, and we have already discussed their possible influence in the causation of albuminuria. As a further step we have to consider the altered condition of the blood in fevers. We do not know much about this, but we know enough to enable us to assert that this factor also can play a certain part in the production of febrile albuminuria. I here refer to what has been stated in a previous page with regard to the influence which the increased amount of urea contained in the blood exercises