Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

81/440 (page 65)

albuminuria, but that differences exist not only as regards the degree, but also as regards the place in which the excretion of albumen occurs. Only after a distinct interval, varying according to the method of experimenting, do these differences become effaced, especially so far as the deposition of albumen is concerned, uniform or nearly uniform condi- tions are then developed in the kidney, all the tissues becoming gradually involved. The albumen escapes most rapidly and abundantly when the vein is occluded, and the escape of blood in considerable quantity is also a regular phenomenon; cutting off the arterial supply would seem to come next as regards these effects, while confining the urine by tying the ureter occupies the last place. What are the causes of the differences in the development of the albuminui'ia and other changes in the kidney, in these various forms of congestion ? In estimating the processes, we may be guided by the changes of pressure in the blood- vessels and lymphatics, and the disturbances of nutrition which are invariably associated with certain degrees of these changes, since in all cases of congestion, however produced, there is a retardation of the current of blood, with disturb- ance of nutrition as a constant accompaniment as time goes on. These two factors, the retardation of the current and the disturbance of nutrition, must therefore not be separated from each other. It must also be remembered that in the production of urine two factors co-operate, viz. the glome- rular vessels which are governed by the laws of filtration, so long as their nutrition is unaffected, and the glandular epithelium proper, which is subject to influences of a different character, and only partially understood. The process takes the simplest form when the arterial supply is interrupted, that is, when the congestion is the result of ischsemia. The natural consequence of this inter- ruption is that the blood-pressure in both capillary systems of the kidney falls below the normal. How the filtration in the capsules will be thereby affected can be stated with certainty; thete will be a diminution in the quantity of the filtrate, but an increase relatively in the amount of albumen it contains (compare p. 28) ; and this will be decidedly the first direct effect of the diminution of the pressure, and one 5