Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

134/440 (page 118)

tliose diseases of the kidney. Its proportionately rapid supervention, the great extent of the anasarca, and above all its localisation, would rather seem to indicate the exist- ence of special local abnormalities, which Cohnheim is inclined to look for in some inflammatory change of the skin or its vessels. It is in fact difl&cult, without some such assumption, to explain how it comes to pass that, in the first form of chronic nephritis (and also in acute nephritis), the eyelids or the scrotum are the usual seats of the oedema, and often those which are first affected; for, as regards these parts, the influence of gravity cannot be a sufficient cause for the appearance of the symptom.^ How different are the features presented by the genuine renal cirrhosis ! Even in this affection a period of dropsy may set in, especially if the heart's action becomes defective and the typical features of the disorder become obliterated. The condition of such patients obviously then resembles that of cases of heart- disease in the stage of defective compensation, and especially with regard to the dropsy, which in these latter depends mainly upon venous congestion. Hence in these cases the localities in which oedema first appears are the lower extremi- ties, and the dependent parts in general; and this oedema is accompanied by more or less intense cyanosis, of which no trace is exhibited by the dropsical patients included in the first category, unless, perhaps, some special causes supervene in addition. All these diversities serve to explain the dissimilar con- ditions of the urine in the two typical forms. In the one, the large white (mottled) kidney, the condition which influ- ences the result is the abnormal permeability of all the elements of the tissue, due to the swelling and fatty degen- eration of the epithelium, and to the infiltration of the organ by round cells ; a condition from which the glomeruli and their capsules are not exempt. Under these circumstances, the transudatory and secretory apparatus must necessai-ily yield a highly albuminous fluid, in the production of which 1 In two cases of scarlatinal dropsy without albuminuria I noticed ajdema of the face alone in one instance ; in the other only oedema of the face and scrotum, persisting for several weeks, in the latter case without the previous appearance of any other trace of dropsy.