Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

129/440 (page 113)

tlieyare tlie starting-point for the inflammatiorij as 1ms been sliown by the investigations of Klebs^ Salviolij Colmlieim, Friedlauderj and Ribbert (gg) on the subject of glomerulo- uophritis. In all cases the deposit of exudation in the Bowman-Miiller's capsules can be easily demonstrated. The possible participation of the interstitial vascular system in the excretion of albumen mnst_, however^, be assumed, because the interstitial tissue and the epithelium of the uriniferous tubules almost always become involved^ and an escape of albumen into the interior of the tubules may doubtless take place in consequence. But from the anatomical appearances it is easy to form a conception of the condition of the urine in some other respects in every case of acute nephritis, and it would appear especially that the diminution in the quantity must necessarily be referred to the co-operation of several conditions. In the first place the glomerular vessels are compressed, on the one hand, by the escape of the exudation into the capsules, and by the cell- proliferation proceeding from the walls of the latter; on the other hand, their walls become infiltrated with fluid and swollen, and their calibre greatly diminished. A second factor is the retardation in the current, which, according to Cohnheim, takes place in inflamed tissues; and, lastly, the uriniferous tubules situated in the inflamed interstitial areas must become occluded by the pressure from without, and by the infiltrated and detached epithelial cells. It is, I think, a less easy and a less simple task, to arrive at an explanation of the processes which take place in those renal affections which are embraced under the term chronic nephritis or chronic form of Bright's disease.'' This is not the place to enter minutely into the question, so warmly discussed of late, as to whether all those affections included under that designation, are naturally connected aud invari- ably depend on one and the same process, or whether and to what extent they are to be distinguished from each other. It is the less necessary to discuss this question inasmuch as no great difference of opinion prevails on those points in which we are now interested, that is, with regard to the con- <lition of the urine, and to the anatomical appearances in the kidney—the differences in question mainly relating to the 8