Selected monographs.

Date:: 1888

Catalogue details

Licence: Public Domain Mark

Credit: Selected monographs. Source: Wellcome Collection.

91/440 (page 75)

case before us, liowever, differs from the experiment in whicli tlie artery is tied, in the fact that an obstacle is introduced in the direction of the current of venous blood, the pulmonary vessels and the right side of the heart being engorged with blood. The effect, therefore, with regard to the difference of tension between arteries and veins, which is the main point in the question, may be exactly similar: in the experiment, in consequence of the marked diminution of the arterial pressure, the flow through the vein being unim- peded : in the pathological conditions, in consequence of a smaller diminution of the arterial pressure, but with a co- existing impediment to the escape of blood through the vein. It comes to pass, therefore, that there is an anatomical resemblance in the main feature between the kidney in the ordinary state of congestion and in that due to cutting off the arterial supply, any difference being due only to the fact that in the human subject death does not result as soon as the congestion begins, and that this latter condition is of longer duration, time being thus afforded for the development of those consequences of stagnation which have been already mentioned. There is seldom an opportunity, except in cases of sudden suffocation, to examine kidneys in a marked state of venous congestion of recent origin, and in which, when death took place, the congestion had rapidly advanced so far as to produce albuminuria. In the few cases which have come under my notice, and which to some extent coincided with the requirements, a very moderate increase in the size of the kidney was the only thing to be observed; but this did not even approximately resemble that enormous increase which took place in a rabbit's kidney after tying the vein, and never even once reached the degree attained in cases of recent inflammatory swelling of the kidney. The congestion presented the usual appearances, being most marked in the pyramidal portion in which veins are numerous, but less prominent in the Bowman-Miiller's capsules. Under the microscope a deposit of albumen was not always to be found, at least not in every section; where, however, it was present, it was contained almost invariably in the capsules alone. The results, therefore, of clinical observation coincide, in a manner practically complete, with what follows when the