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

  • Stewart, Thomas Grainger, 1837-1900.
Date:
1864
Catalogue details

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.

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    rouleaux, like healthy corpuscles, tliey become stretched out into long, spinilie-shaped bodies. The blood changes I have observed only when the degeneration affected the lymphatic or blood glands. The patient may continue in this state for months, or even years— may, indeed, undergo a temporary improvement—the liver and spleen becoming diminished in bulk, and the blood resuming a more healthy character; but, sooner or later, for the most part ascites or general dropsy gradually supervene, accompanied fre- quently by diarrhoea, which is at times found quite uncontrollable. The urine, now very albuminous, diminishes in quantity, so as at times to be almost or altogether suppressed; effusions into the serous cavities or severe bronchitis ensues ; the patient becomes exhausted and sinks, or drowsiness comes on, and the disease terminates amid coma and convulsions. Further experience has confirmed the opinions then expressed, and in all cases in which an autopsy revealed the lesion, and in which I had the opportunity of carefully examining the patients, I ascertained the existence of the symptoms which I have indi- cated. In support of my views 1 adduced in my former communi- cation twenty cases, in nine of which the existence of the lesion was ascertained by post-mortem inspection. In the present paper I shall complete the history of three of these, continue that of another to the present time, and give a summary of fourteen other cases, in several of which autopsies have been made. Case I.—A. M., slioemakcr, set. 33. Ilis case was minutely described in tlie previous paper. Of a sypliilitic constitution, he was, about four years ago, under treatment in the Inlirmary for enlargement of the liver and spleen, with slight Icucocytheniia. He had no dropsy, but made a large quantity of water, of low specific gravity. From his history and the urinary symptoms, I ventured to anticipate the appearance of albumen in the urine. It was carefully tested, day by day, and, after a while, a ti-ace of albumen appeared; this gradually increased; and afterwards tine hyaline tubecasts were occasion- ally seen in the urine. These symptoms had lasted for about nine months at the date of my former publication, and since that time they have steadily continued. The following notes were taken at the dates mentioned :— — ith February 18(^1.—The liver and spleen have fiirtiier diminished in size. His appeai-ance is somewhat less cachectic. For some days he has had a paiu in the neighbourhood of the umbilicus, and along the margin of the liver, aggravated on movement or on pressure, and after eating. The stools are of ^ a dark colour, and contain some bright red blood. He has no piles. The ^ amount of urine contiiiucsjiigh, about 120 oz. dailyis albuminous.^M*^ f Bth October 1861.—Thepatrenf'agfun preFenled 'litlti^lf;TIis cacTiectic appearance is increased ; he complains of a severe pain in the lumbar region, and along the spermatic cords. His renal symptoms continue unchanged, and the liver is still distinctly enlarged^ C^ice that time he has frequently presented himself at the New Town Dispen- sary and elsewhere; has repeatedly been an inmate of the Koyal Infirmary; has been able occasionally to work at his occupation of shoemaking, and has of late acted pretty constantly as cook to the Mid-Lotliiaii Militia stationed at Dalkeith. 'Phe-kst-HOtaJJiave lalcen of his-esse .w»s ou 21 st ]\r;ir( !rNJ864. He continues r to mai<e large quantitie| of water daily, usuallv upwards'of 120 oz. It is still albuminous, but no tub|casts have been discovered lor some time. The hepatic dulness is diminished to about six inches; the organ is still pahiful on pressure.