Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

127/440 (page 111)

upon the filtration of albumen (see page 97, et seq.) The above-mentioned factors are assuredly sufficient for the explanation of every febrile albuminuria in the ordinary sense of the words, involving as they do only the excretion of coagulable albumen. But the possibility is by no means excluded that the febrile varieties of the metamorphosis of tissue, the changes in the condition of the blood, unknown it may be to us, but doubtless present, may serve as a screen for a number of other factors favorable to the deve- lopment of albuminuria. This supposition must almost necessarily be accepted with regard to the instancea designated by Gerhardt as latent albuminuria, in which albuminous substances, non-coagulable by heat, were excreted; and consequently for cases of peptonuria or propeptonuria, as these occur not merely in non-febrile but also in febrile diseases, and, as it would appear, often under the influence of the fever alone, and not of the particular disease which the latter accompanies. The few statements that can be made on this subject have already found a place in the fore- going sections (see pp. 8 and 107). Unfortunately, under the circumstances, the domain of facts has its narrow limits while there is a wide field for hypothesis. This wide field would have to be thoroughly traversed if the attempt were to be made to explain every instance of albuminuria occurring in the course of disordered states, but without the kidneys being deeply involved. I do not assert that the morbid processes are everywhere enveloped in so much obscurity, that the causes which have led to the albuminuria are always beyond our comprehension. This is by no means the case, for in this or that disorder the par- ticular circumstance to which the albuminuria is due can often be definitely specified; we know, for example, that the albuminuria in cholera is due to the great inspissation of the blood, whereby it is made to contain more albumen and, for a short time, more saline constituents (see pp. 97—99); secondly, to the intense venous congestion of the kidneys; and lastly, to that degeneration of the epithelium and walls of the vessels which necessarily results when the tissues are tra- versed by abnormally constituted blood flowing in an abnor- mally retarded current. Each of these factors majper se, as