Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

72/440 (page 56)

In venous congestion of the kiclueys tlio processes are vastly more complicated and difficult to fathom. It is true that the experimental investigations on this subject have shown, with a mutual conformity otherwise rare, that apart from other changes, the urine under these circumstances always becomes albuminous, and with this result the expe- riences of renal congestion in the human subject seem to accord, so that there has been no hesitation in interpreting in the same sense all the experiments having for their object the arrest of the venous blood; and in regarding all of them, like the clinical examples, as of equal value. If, however, we look more closely into the matter, we find that there are very important differences among the experiments, and to a greater extent between them and the clinical exam- ples, in spite of the fact that a certain similarity exists. With regard to the clinical examples, we do not require much experience to know that, in the first place, with the exception of those extremely rare cases which have scarcely any clinical significance, the phenomena of congestion in the human subject are induced by conditions which lower the pressure in the aorta, and that in the proportion in which this takes place the congestion becomes increased ; and in the second place, that the conditions generally become deve- loped very slowly, that is to say, in the course of many weeks, or at least days, and hardly ever in the course of a few hours or minutes. In the experimental investigations performed for the purpose of explaining the conditions in the human subject, there is much that contravenes the above experiences. In order to produce congestion, the pre- ference has been given to experiments in which the renal vein is tied, and these have been used for purposes of com- parison, although inasmuch as the arterial supply to the kid- neys continues unchanged, the circumstances are the oppo- site of those of the pathological conditions of the human subject. Moreover, in the majority of cases, and especially in recent times, when these questions have assumed considerable prominence, the effects of the various operations regarded as necessary have neither been gradually induced nor allowed to continue for a brief period, but suddenness and extreme results have been aimed at, and thus, for example, the move-