An account of five cases of pyelitis in enteric fever / by John Brownlee. With a description of the post-mortem appearances in one case / by E.S. Chapman.

  • John Brownlee
Date:
[1906]
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Licence: In copyright

Credit: An account of five cases of pyelitis in enteric fever / by John Brownlee. With a description of the post-mortem appearances in one case / by E.S. Chapman. 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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    the urinary tract are inflamed. Thi.s, in two ca.ses, was succeeded on the third day by the presence of epithelial and granular casts, indicating inflammation of the kidney. In both instances where these ca.sts were present there was a very considerable amount of albumen in the urine, much out of proportion to that which the presence of blood would account for. In both these cases it is to be noted that the symptoms of nephritis disappeared in five or six days. The .symptoms, then, which remain belonging to pyelitis proper seem to be the presence of blood in the urine, with a certain amount of tailed epithelium, which rapidly, in two or three days, is replaced by the ordinary pus cells and the protracted appearance of the latter in the urine. In two cases the origin of this pus was more or less identified with the pelvis of the kidney by the result of ])alpation, in Case IV by tendorne.ss in the region of the left kidney; in another (Ca.se I) the aVwence of pus in the urine for two days was found as.sociated with a definite enlargement of the left kidney which could no longer be perceived after the pa.ssing of a specimen of urine largely consisting of pus. One interesting point in connection with the jiresence of blood in the tirine in pyelitis is the dilliculty with which the characteristic reaction with guaiacum is freciuently obtained. Unfortunately, spectroscopic examina- tions were not made in any of the cases. The blood always occurs witli the onset of the illness, but may continue to appear in small (piantities and at irregular intervals for some time after the condition has become cstablisheil. The light thrown on the clinical symptoms by the pathological de.scrip- tion by Dr. Chapman is considerable. The focal lesion in the kidney explains the temporary nephritis observed in two instances as well as the pre.sence of a certain amount of l)lood in the urine, while the degree of congestion and apparent fragility of the blood-ve.s.sels of the pelvis which are subjacent to the epithelial surface is .such as cannot but cause marked haiuiorrhage, resulting in the pigmentation of the urine referred to. The duration of the condition is seen to be very variable; in one case the whole course occupied no more than six days, in another it lasted twenty-two days, while in other two pus was still present in the urine in minute (|uantity about three mouths after the on,set. Post-mortem appearances in a case of enteric pyelitis, hy K. S. Chapman, M.D.—The occurrence of jiyelitis as a comjilieation in enteric fever is of some rarity. ^I’he literature