Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

135/440 (page 119)

the swelling and degeneration of the epithelium, namely, of the capsules, glomeruli, and uriniferous tubules, though not unconcerned in the escape of the albumen (see page 78), have not even been taken into account. It is evident that there will be no lack of blood and pus-corpuscles, epithelial cells and casts, whether these last are formed out of coagulated albumen or epithelium. In like manner it is obvious that the urine must be reduced in quantity in conse- quence of the pressure which the infiltrated cells exercise upon the capsules and glomeruli, and likewise upon the uriniferous tubules, and in consequence of the more or less decided occlusion which will take place in the last-named structures as a result of the swelling, degeneration, and detachment of the epithelial cells. In this respect the con- ditions resemble those of acute nephritis, but in the latter the progress of the symptoms is of a more violent character, and corresponding with the acuteness of the inflammation, is marked by intense hypergemia and considerable hsemorrhage. But even in the chronic form, to which we are now alluding, such acute exacerbations are by no means rare; on the other hand, an improvement may set in, the morbid process coming to an end in certain spots, though complete restoration does not take place. That such changes occur is shown by the varying condition of the urine, and especially by the diminu- tion from time to time of the formed constituents. We have already stated that it is more than probable that simultaneously with this nephritis some peculiar disorder of the skin sets in, causing it to become oedematous. When this is the case, it is obvious that an improvement may occur, .accompanied by absorption of the watery effusion, which is more freely removed by the kidneys, if at the same time the morbid process of which they are the seat undergoes an improvement or its progress becomes arrested. But even in the absence of any such improvement in the state of the kidneys, the absorption of copious effusion would cause a strong current of fluid to set in towards these organs, and any inflammatory products that might be present would be thereby steadily removed. As a matter of ^ fact, we often notice that as oedema disappears, the urine becomes more abundant, but without losing any of its