Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

88/440 (page 72)

In five cases it is twice mentioned that the urine contained blood, so that these may be regarded as confirmatory of our explanations. These ■ latter are also supported in a very marked manner by Bartels' case, already referred to (see p. 26), and in many respects so very interesting, of throm- bosis of the inferior vena cava occurring in a robust man, a case presenting precisely the same conditions with those in Weissgerber's and Perls' experiments, viz. obstructed venous outflow with unimpeded arterial supply, and this, moreover, is the only known case of the kind in which any reference is made to the quantity of the urinary secretion. In this case the result has been,'' to quote Bartels' own words, not only a profuse secretion of urine, but also the escape of albumen, and even of considerable quantities of blood into the urine, probably in consequence of rupture of several vascular tufts of the glomeruli. If an obstacle to the venous outflow, limited to one renal vein or to the inferior vena cava, is formed in the human subject, the conditions under which this generally occurs do not permit of any comparison with venous occlusion produced by experiment, since the arterial pressure is simultaneously diminished. This is what occurs, for example, in the most common clinical thrombosis of the renal vein of new-born children, for this is always of marantic origin. But even in the veiy rare cases as well, in which the vein is occluded by tumours, generally of a malignant character, other complications being likewise present, the arterial pressure is usually in a similar condition. Corre- sponding with this, there is in these cases a difference as regards the quantity of the renal secretion. According to the rapidity of the development and growth of the obstacle the urine invariably becomes more or less scanty, and at the same time contains much albumen and blood. The admixture of blood distinguishes this urine from that which usually and frequently occurs in congestion in the human subject, this condition of the kidney being the result of diminished cardiac activity. The conditions are different from those of artificial venous occlusion, and BO likewise are the consequences as regards the renal secretion. The statement so frequently made to the effect that the ordinary urine of congestion in the human subject