Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

43/440 (page 27)

and tlio escape of albumen and blood, find their inter- pretation in the increased pressure in the glomerular vessels. Heidenhain's supposition is also contradicted by other clinical experiences, not perhaps in such a striding manner as by the above-mentioned case, because the conditions are less simple. They are fully deserving, however, of being mentioned. Thus it is a well-known fact that in certain stages of chronic nephritis and nephro-sclerosis, a very watery and more or less albuminous urine is secreted, whereas the glomerular vessels are in a great degree or almost entirely destroyed, and their epithelial investment has completely perished. Under these circumstances no secretion of water can occur from these parts. The second case, increase of blood-pressure with accelera- tion of the current, has often been a matter of experimental and clinical observation, and will be thoroughly discussed in subsequent pages. It may here be remarked that under these circumstances, in which there is no kind of question of any disturbance of nutrition and function, albuminuria may occur, a fact utterly irreconcileable with Heidenhain's view, but perfectly intelligible if we adopt the filtration theory. How it comes to pass that albuminuria is not to be discovered in every case of increased blood-pressure of a like kind, will be discussed later on, when we come to deal with this subject (S. III). A consideration of these details will cause us to accept without scruple the generally received view which forms the starting-point of the above description, namely, that the fluid which escapes from the glomerular vessels is a transu- dation, formed in accordance with the laws of filtration, and not a glandular secretion. In this respect I adopt Ludwig's theory of the secretion of urine, but I differ from him in regarding the filtrate as not wholly free from albumen. On the other hand, in another respect, I completely assent to Heidenhain's theory, in so far as he considers that the epithelium of the tubuli uriniferi are actively employed in the secretion of certain specific constituents of the urine. It appears to me that this combination of the two theories satisfactorily gets rid of all the difficulties particularly connected with the simple filtration-theory, and which have