Selected monographs.

Date:: 1888

Credit: Selected monographs. Source: Wellcome Collection.

90/440 (page 74)

$some influence on the formation of uric acid in the system (69). At the same time that the water becomes diminished, or shortly afterwards, albumen is often to be found in the urine, but al\yays in small quantity, provided that the condition is that of congestion and nothing more. It would seem that this statement cannot be too often repeated. It is true that when the congestion is of long duration and of great intensity, the quantity of albumen is much increased at a later period, but the consecutive phenomena of the stagnation of blood and lymph (inflammatory processes and conditions of induration, nephritis from passive congestion), have by that time invariably made their appearance. Blood is—and this is a fact which must be repeatedly insisted upon—scarcely ever present in macroscopic quantities, and even with the microscope it is only in a minority of cases that we are able to detect isolated red blood-corpuscles, and generally a few colourless cells. It appears to be doubtful whethei', in such cases, this slight admixture of blood has its origin always in the renal paren- chyma, rather than from the mucous membrane of the bladder, ureter, or pelvis of the kidney; for, as a general rule, the mucous membrane of these parts is the seat of more or less marked hypersemia which, as in other mucous membi'anes, may give rise to more or less considerable haemorrhage. Pale (hyaline) casts are often found associated with the albumen. We have thus given the details of the ordinary kind of renal congestion with which every physician is familiar. Another circumstance, equally well known, may be added, viz. that so soon as the heart recovers its power, the. urine very rapidly returns to its normal condition. I need only refer to the action of digitalis in cases of mitral deficiency. In its origin and the way in which it becomes developed, this form of renal congestion obviously most resembles that which is induced when the arterial supply is cut off for a brief interval or in an incomplete manner, for in both cases diminution of the arterial pressure within the kidney is the first thing that happens. In the experiment certainly, in order to produce the most striking phenomenon in the brief period of observation, the arterial pressure is very considerably reduced, or perhaps altogether abolished, a condition not belonging to the pathological examples. The$

Selected monographs.

Licence and re-use

Contents