Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

131/440 (page 115)

chronic renal affections ; the one described as the large white or mottled kidney (chronic parenchymatous, diffuse nephritis, Weigert's sub-chronic nephritis, &c.), and the other known under the name o£ the red granular or contracted kidney (genuine renal cirrhosis); the former is the more inflammatory form, the chief microscopical characters of which are swelling and fatty degeneration of the epithelium of the uriniferous tubules and accumulation of round cells in the interstices (and likewise in the Malpighian capsules) ; the latter is more of an indurated character, in consequence of the development of a firm connective tissue with but few cells and tending towards atrophy, and of wasting of the glomerular vessels. I repeat that there are these two forms, standing out clearly by reason of their marked character, but I also lay stress upon the fact that all chronically diseased kidneys by no means corres- pond exactly to one or the other type, but that numerous cases occupy an intermediate position between them, or approach partly to the one and partly to the other type ; and that conse- quently these two types may be regarded as the terminal extremities of a series in which there are gradual transitions from the one extremity to the other. And this further remark must be made that the first form may even clinically pass by degrees into the second, and inasmuch as we are accustomed to regard the anatomical changes in both cases as of an inflammatory nature, those of the first type being of more recent origin, those of the second of an earlier date- and as resulting from the former, we may well suppose that the- second type represents, in its anatomy at least, a later stage- of the first type, or, at all events, a slower form of develop- ment. But the question inay well be asked, do all these- considerations constitute a sufficient reason for adopting a, modern view, which regards all forms as mutually connected m every respect, and promulgates the doctrine of the unity of chronic nephritisor of « Bright^s disease of the kidney If this view be a reasonable one, then no distinction, clinical patient appears to be in good health. Notwithstanding the long duration of the disease there is not a single symptom of hypertrophy of tlie heart, and there is no ground whatever for tlie suggestion of amyloid disease, in which the hypertrophy is absent. On tlie other hand, it is well known that in the second type the earl.est symptom of renal disorder is usually accompanied by cardiac hypertrophy, which can for the most part be eUnically demLstratccf