An investigation into the microscopic anatomy of interstitial nephritis : being a gold medal thesis for the degree of M.D. in the University of Edinburgh / by Bryan Charles Waller.

  • Waller, Bryan Charles.
Date:
[1878?]
Catalogue details

Licence: Public Domain Mark

Credit: An investigation into the microscopic anatomy of interstitial nephritis : being a gold medal thesis for the degree of M.D. in the University of Edinburgh / by Bryan Charles Waller. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    But, as lias been often before mentioned in the present treatise, the very early stages of Interstitial Nephritis rarely come under clinical, far less under pathological, observation. What, therefore, the morbid anatomist recognises as an early stage of interstitial change, may in reality be the product of a morbid process which has lasted for months. Interstitial Nephritis is essentially chronic, or at most subacute; the fatality of its initial stages is almost nil; and a sufficient time, consequently, elapses between its supervention and its recognition at the autopsy, to allow of even the tardy develop- ment of muscle cells. The absence of hypertrophy of the muscular coat in the author's speedily fatal cases of Glomerulo- nephritis, further tends to strengthen these conclusions. In a monograph like the present, which deals solely with the Morbid Anatomy of interstitial kidney, it would be out of place to propound or endorse any theory as to the cause of this muscular hyperplasia; suffice it to say, that the author is convinced of its existence. (See Plate iv.) The hypertrophy is far too great to admit of its being explained away on the ground of post-mortem contraction, analogous to the so-called concentric hypertrophy of the heart. The muscular coat is frequently two or three times as thick as in normal arteries, and no possible amount of mere contraction could give rise to such an appearance of increase. Confirmatory evidence in favour of its true muscular character is given by Dr Grainger Stewart (Brit Med. Jour., Sept. 6, and Nov. 15, 1873); by Dr Atkins (Brit Med. Jour., April 3, 1875); by Dr T. J. Maclagan (see Report of Trans, of Med. Chir. Soc, Edin., Brit. Med. Jour., June 5, 1875); rather hesitatingly by Dr Galabin (On the Connection of Bright1 s Disease with Changes in the Vascular System); and in the 2d edition of Jones and Sieveking's Pathology, by Payne. Again, on examining the arterial coats in longitudinal section, the mus- cular nuclei are seen in greater numbers than in unaffected vessels; which not only proves the true nature of the hyper- trophy, but at the same time negatives the theory of post- mortem contraction. Sir W. Gull and Dr Sutton say the muscular layer varies in thickness, and that it is difficult to say what are or are not its normal dimensions. Well, so do men vary in stature; yet if we meet with a man eight feet high, we call him a giant. How much more Brobdignagian, then, should we consider him if he towered above our diminished heads to the height of twelve or eighteen ] Yet
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