Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

86/440 (page 70)

the discharge through the vein is not entirely checked, for if it be, the function of the kidney is rapidly extinguished (see p. 60). Cohnheim's researches upon venous congestion (under conditions, as in the case before us, of unimpeded artex'ial supply), justify the conclusion that in the parts in which transudation occurs, the glomerular vascular system, there will be an escape of fluid, in quantity exceeding the normal and containing blood. Both of these, the quantity of fluid and the blood, are in direct proportion to the degree in which the pressure of congestion exceeds the normal amount; and the blood especially is the characteristic which distin- guishes the transudation of congestion from that which is normal, and likewise from that yielded by the kidney when only the arterial pressure is increased ; and whether the blood-cor- puscles escape by diapedesis, or in consequence of rupture of vessels, is for our present purpose a question of no import- ance. The condition of the secretory apparatus may also be determined with some degree of certainty, although in this case a comparison with the liver is again wanting. For, so far as I am aware, no observations have been made with regard to any changes which may occur in the bile after ligature of the hepatic vein. But we may regard it as certain that an oedematous gland—and, with such we are certainly dealing at present—not only secretes more copiously, but also allows albumen (and probably also blood) to pass abnormally into its secretion, as a matter of course from the interstitial vessels. This is also proved by the discovery of albumen between the epithelium and the membrana propria, an appearance which, in this form of congestion, is speedily produced at a much earlier period than in the other forms in which it may occur after a longer interval. If, however, this hypothesis be rejected, and the albumen in congestion be supposed to escape from a source other than the glomerular vessels, it would then be necessary to interpret these appear- ances by supposing that the epithelium first became detached, and then that albumen drained from the capsules between the epithelium and the membrana propria. It is, however, easy to foresee the relation that would then exist between the basement membrane which had lost its epithelium and the