Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

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already explained, give rise to albuminuria ; two or three of them combined will, as a matter of course, be the more certain to produce it. With regard to the temporary albumi- nuria, not seldom to be observed in diarrhoeas of other kinds, and which has recently attracted attention (98), we are to some extent justified in attributing it to the diminution of the water of the blood and the diminished blood-pressure which usually co-exists; but these exhaust the category of morbid conditions, apart from kidney disorders proper, in which there are at least a few facts as a basis of support for the ex- planation of any existent albuminuria. There are, as a matter of course, on the whole but few •diflaculties in explaining the excretion of albumen in renal disorders proper, i.e. nephritis in its various forms and amyloid degeneration; that is to say, in those processes in which albuminuria is so constant and so marked a pheno- menon that they were in former times simply identified with it. And the acute inflammatory processes are the simplest of all as regards the facility with which the albuminuria can be explained. For the fact is that each vascular portion in a state of inflammation is abnormally permeable, and permits the escape of a fluid containing in particular a large amount of albumen and of cells in addition. Albuminuria is con- sequently a necessary symptom of all active inflammations in the kidneys, that is, both of those forms which are acute from their commencement and throughout their course, and of the acute inflammatory exacerbations which occur in the chronic forms. If it be not invai'iably observed in inflammations of a purely circumscribed character, the reason for this may be partly because the connection of the inflamed portions with the discharge-tubes is interrupted, and partly also because the amount of albumen yielded by the area in question is too small to be detected, especially if such circumscribed inflam- mations do not affect the glomerular vessels. For there can be no possible doubt but that the glomeruli are invariably the principal and most prolific source of the albumen, and hence it is that the urine containing the highest proportion of albumen is always yielded in cases of acute (diffuse) nephritis. In every acute inflammation of the kidney the glomeruli are especially affected, or we may rather say tha t