Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

42/440 (page 26)

current must produce a disturbance of the nutrition and function of tlioso epitliolial cells^ and as a consequence, diminution of the quantity of urine and escape of albumen. In the second case, increased secretion of urine free from albumen is the necessary consequence. But this is not what really takes place. The first condition, increased pressure with retardation of the current, can be very easily produced by entirely or partially closing the renal vein or the inferior vena cava, but it is difficult to form any definite conclusion with regard to the alterations in the quantity of urine under these circumstances, the only positive fact being that the urine is thereby rendered albuminous. In the human subject, in which it is easier to observe quantitative changes in the urine, occlusions of the renal vein or inferior vena cava very rarely occur, and almost always under conditions in which the arterial blood-pressure is reduced, as takes place in marantic thrombosis, or in occlusion due to cancer, &c. Only in very rare exceptions has arrest of the escape of blood from the kidney been observed in conjunction with well- maintained cardiac activity and normal arterial pressure. For a case of this kind we are indebted to Bartels (31). It was one in which there was impeded escape of the blood of the renal vein, in consequence of thrombosis of the inferior vena cava, occurring in a very robust man, forty-four years of age ; it was, therefore, not a case of ordinary congestion as a result of defective action of the heart, in which there is also diminution of arterial pressure. Now this patient, as Bartels states, passed enormous quantities of urine (on an average 1640 ccm. daily in spite of most mai-ked osdema), generally containing a considerable quantity of blood, and with a specific gravity varying from I'oii to i •013, and always con- taining much albumen and a sediment of red blood-cor- puscles and epithelial and other casts. This case furnishes evidence of a more decided character than any experiment against Heidenhain's view of the function of these epithelial cells. For in spite of the retardation of the current, which obviously existed, there was no diminution, but a consider- able increase in the quantity of the urine. According to our view, which moreover is admitted as an explanation by Bartels, both phenomena, viz. the increased quantity of urine