Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

130/440 (page 114)

development and succession of the processes^ and to tlie relation whicli the hypertrophy of the heart, and the vascular changes in general, bear to the renal affection. It is thus -almost universally admitted that, from a clinical point of view, there are two well-marked types of chronic kidney disease. The first of these exhibits from the commencement the follow- ing characteristics : more or less extensive anasarca, marked ansemia, highly albuminous urine abounding in morphotic constituents (casts, red and white blood-corpuscles, epithelial cells), scanty in quantity when the disease is at its height, or scarcely reaching the normal amount, and, lastly, no mani- fest hypertrophy of the heart. The second variety commences without anasarca, and generally without any remarkable dis- turbance of the general health; the urine is limpid, clear, poor in albumen, but excessive in quantity, and these symptoms are usually associated with hypertrophy of the left side of the heart. Every physician who has had only a moderate amount of experience is acquainted with cases of disease which correspond to the one or other of these types—cases, the symptoms of which, without any other disease or any precursory stage, make their appearance exclusively in one or other of these modes, and which run their course for many years, it may be, with variations in intensity until death ensues.-^ In like manner, considered anatomically, two typi- cal forms stand out sharply from the great variety of all > In discussing tte question of the development of cardiac hypertrophy in renal diseases, several authorities attach considerable importance to the influence of the prolonged duration of the latter, and the chronic character of their course, and I therefore make the express remark that I have repeatedly seen cases belonging to the former of the above-mentioned types o-oino- on for many years without cardiac hypertrophy, hut with good general nutrition, if death occurred before the above-described first type became changed; that is, before it passed into that named by myself and others, seconda/ry atrophy, a process the development of which may require many years. It is true that in these cases the whole series of symptoms was not un- interruptedly present; the dropsy altogether disappeared at intervals, whereas the albuminuria, and, therefore, the renal lesion as well, were continuous. At the present time there is in my division of the hospital a strong cai'i^enter, admitted for the third time, who a year and nine montbs ago fii-st fell ill with symptoms of the first type of nephritis, but apparently regained his strength and went on with his worlc. After being under treatment for several months the dropsical symptoms have now again abated, and the