Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

137/440 (page 121)

12} certain,, tliat in this cirrhosis, in which tho largo majority of the glomeruli are not seldom destroyed, tho increase in the quantity of the urine is in great measure due to the increased activity of the secretory epithelium, a large portion of which is usually in a normal condition. This view is further sup- ported by the fact that the quantity of the specific urinary constituents (at least of the urea), secreted by such kidneys, corresponds absolutely with the conditions connected with the nutrition, though the percentage is reduced. The epi- thelium in this case acts similarly to all other glandular epithe- lium when under increased arterial pressure {conf., p. 40). Disorder of the skin with tendency to oedema, as occurs in the first type, or in acute nephritis, is absent in the- typical cirrhosis, although the cutaneous arteries are not seldom thickened just as those in the kidneys (loi). This vascular disorder, however, is not such as to cause oedema. It is only when the heart's action becomes feeble that osdema and other effusions set in, and are accompanied by decreased secretion of urine. I must repeat that the above descriptions correspond only to the marked types of chronic nephritis, to those which stand at the ends of the scale, and that there are numberless cases in which the typical characters are more or less obliterated. To arrive at a proper estimate of these con- ditions it will always be useful to remember the analogy they present with chronic inflammations of the lung, the mutual relationships of which, however, are more distinct. Finally, with reference to amyloid degeneration I can be very brief in my remarks, for I have little that is positive to state with regard to the influence of this condition upon the secretion of urine. I agree with others in supposing that the vessels in a state of amyloid degeneration are abnormally permeable, and therefore offer less than the normal obstacle to the escape of the albuminous substances dissolved in the blood. No strict proof can be adduced for that hypothesis, which, however, is perhaps supported by the fact that obstinate diarrhoea is such a common symptom in cases of extensive amyloid degeneration of the intestines. This may, however, be due rather to defective absorption and increased peristaltic action. It