Diseases of the kidneys and of the spleen, hemorrhagic diseases / by H. Senator and M. Litten ; edited, with additions by James B. Herrick ; authorized translation from the German, under the editorial supervison of Alfred Stengel.

  • Hermann Senator
Date:
1905
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the kidneys and of the spleen, hemorrhagic diseases / by H. Senator and M. Litten ; edited, with additions by James B. Herrick ; authorized translation from the German, under the editorial supervison of Alfred Stengel. 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.

    174/858 page 162
    ations in the aiFected kidney; but if the condition is protracted there develop either complete necrosis or coagulation necrosis and fatty degen- eration, particularly of the epithelium of the convoluted tubules, depending on the degree of completeness of the occlusion, as has already been explained. The only positive symptom produced by simple anemia or ischemia of the kidneys is diminutioyi in the quantity of urine, which may go on to complete anuria. The other changes, especially the appearance of albumin, blood, casts, and cells, are in all probability caused by the tissue changes secondary to the anemia. Of these, fatty degeneration of the epithelium, unless it has gone too far, appears to be least produc- tive of consequences. Among the morbid conditions that are thought to be in part caused by ischemia of the kidneys is fatty degeneration of the epithelium, which generally attends chronic anemia and is regarded as the result of the slowly progressing decrease in the entire mass of the blood ; coagulation necrosis has been found repeatedly in the kidneys of women who had died of puerperal eclampsia, and has been attributed in these cases to the universal arterial spasm (Schmorl,^ Beneke ^). The kidney changes in cholera and during pregnancy have also been interpreted as ischemic in character, although the conditions in these cases are more complicated, and other causal factors besides the diminution in the blood-supply are unquestionably at work. On the other hand, there is much in favor of the theory that the cases of oliguria and anuria which occur in hysteric subjects (Charcot,' Fernet,* Sanquer ^) are attributable to anemia from vascular spasm—i. e., angiospastic ischemia ; this applies particularly to cases of reflex anuria in one kidney occurring after intense irritation of the other kidney or its ureter; as, for instance, by a calculus. Such cases, which are mentioned by Bonet in his Sepulchretum (Sec- tion XXII.), and by others among the older physicians, have been studied with some care in more recent times by Bourgeois,^ Godlee,' J. Israel, Kirkham,^ A. Barth,^^ and others. [Perhaps some of the cases of anuria following operations on the kidney may be of this character, the kidney not operated upon being reflexly ischemic.—Ed.] Accord- ing to an observation made by McBride and Mann, severe irritation from the genital apparatus appears to be capable of producing the same effect. The anuria in these cases is readily explained by the above- mentioned experimental observations in regard to ischemia from reflex causes, a theory that is confirmed by the good therapeutic results obtained in such cases by the use of narcotic or antispasmodic remedies. ^ Ceniralbl.f. path. An. u. allg. Path., 1891, ii. ^ Klin. Handb. dcr Ham- u. Senialorgane, v. Ziilzer-Oberlander, 1894, i., p. 148. ' Legonsfaites d In snlpet.riere, 1872. * De I'oligurie et de I'annrie hysteriqeues, Union med., 1873, No. 45. * Anurie, etc., Gaz. des hop., 1875, No. 51. 6 Union med., 1855, No. 31. ' Med.-Chi. Trans., 1887, ii., p. 237. 8 Deutsch. med. Woch., 1888, No. 1, and Arch. f. klin. Chi., xlvii., 1894, 2. 9 Lancet, Dec. 7, 1889. i 'Deutsch. med. Woch., 1892, No. 23. Arch, of Med., i., June, 1879.
    digitised image 1
    digitised image 2
    digitised image 3