Further observations on the waxy or amyloid form of Bright's disease / by T. Grainger Stewart, M.D.

  • Thomas Grainger Stewart
Date:
1864
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Licence: Public Domain Mark

Credit: Further observations on the waxy or amyloid form of Bright's disease / by T. Grainger Stewart, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

    3/18
    FURTHER OBSERVATIONS ON THB WAXY OR AMYLOID FORM OF BRIGHT'S DISEASE. In Febniaiy 1861,1 published in this Journal certain views as to the symptoms which accompany the waxy or amyloid degeneration of the kidney, one of the forms of Bright's disease: symptoms which I conceived to be so distinct and constant as to render it easy for us to distinguish during life between this and other forms of renal affection. In this paper I propose to indicate the results of my observation of that disease since the period of my former communi- cation, and the conclusions at which I have arrived. Nearly all the cases have been observed in the Royal Infirmary, and I beg to acknowledge my obligation to the physicians who have kindly perr. mitted me to publish them. The description which I then gave was the following An individual who has long suffered from wasting disease, such as scrofula, caries, necrosis, or syphilis, or who, though without pal- pable disease, is of a feeble constitution, feels an increasing weak- ness, and begins to pass large quantities of urine, and to drink largely. He is, contrary to his usual custom, obliged to rise repeatedly during the night to make water, and on each occasion passes a considerable quantity. The amount of urine varies from 50 to upwards of 200 oz. daily, always bearing a relation to the amount of fluid di'unk, generally nearly equalling it in amount, or sometimes even exceeding it. The feet and ankles become cedema- tous after a hard day's work, but return to their natural condition during the night's repose. In many cases there is observed a hard- ness and swelling in the hepatic and splenic regions, dependent on an increase of bulk of the liver and spleen. The patient feels a constant lassitude and unfitness for exertion. His urine gradually becomes albuminous, and a few waxy or hyaline tubecasts are to be found in the very scanty sediment Avliicli it throws down. It is of low specific gi-avity—1005 to 1015. The blood presents some pccuUarities microscopically: tlic white corpuscles being somewhat increased in number, and the red presenting a flabby appearance, with a marked tendency to tail,—that is to say, instead of forming into