A Treatise On Albuminuria
İÇİNDEKİLERCONTEINTS.CHAPTER I. INTRODUCTORY. Structure of kidney-Its post-mortem state in health--Tables showing appear- ances presented by tubes and epithelium in sixty-five healthy kidneys--Fatty degeration of epithelim--Normal appearances of the epithelium, tubes, fibrous tissue, and blood-vessels--Changes which may be taken as signs of diseanse --Classiification of renal disease-Disease of the tubes, or tubal nephri- tis, sometimes intertubally complicated ; of the fibrous tissue or granular de- generation; of the blood and blood-vessels, or lardaceous change. 1 CHAPTER II. ALBUMINOUS URINE AND FIBRINOUS CASTS IN THEIR GENERAL RELATION TO THE PATHOLOGY OF THE KIDNEY. Albuminuria from state of blood-From alterations in the kidney--Transudation of serum, caused by renal congestion, by peculiar alteration in renal Vessels, or by loss to the tubes of their epithelial lining-Fibrinous casts derived like albumen from the liquor sanguinis--Their varieties and indications. 11 CHAPTER III. PATHOLOGY or. NEPHRİTIS. Change often limited to tubes --Acute form, congested kidney, changes evident to naked eye and With the mioroscope --More chronic variety, large white kid- ney, similarly considered--Obstruotion of tubes--Frequent participation of the interstitial tissue in the--inflammatory process--Fatty degeneration--Renal results of nephritis summarized--Mode of examining kidney with the microscope 16 CHAPTER IV. CLINICAL HISTORY AND SYMPTOMS OF NEPHRITIS. Sex and age of subjects--Causes--Symptoms--Dropsy, laryngeal oedema, infilam- matory and uraemic attacks-Symptoms in children and adults compared-- Tendency to recovery--Duration of disease-Causes of death--Tabular an- alysis of symptoms--Urine; its general microscopical and chemical charac- ters--Cases illustrating natural history of disease 27 CHAPTER V. CAUSES OF NEPHRITIS CONSIDERED IN DETAIL Cold-Circumstances in which nephritis thence arises ; temperate climate predis posing cause; Arctic experiences--Relation of nervous system to inflammation of kidney--Cases of nephritis produced by exposure, in one of which rupture of kidney occurred--Scarlatina as cause of renal disease; resultant organic changes; cases illustrating symptoms and pathology of scarlatinal dropsy-- Other febrile disorders as causes of nephritis--Instance of the origin of the disorder in acute rheumatism-Irritants foreign to the system as causes of renal inflammation; toxic albuminuria. 52 CHAPTER VI. TREATMENT OF NEPHRITIS. Methods pursued by Bright, Christison, Prout, Todd, Johnson, Bence Jones, etc. --General consideration of principles and details of treatment : blood-letting, use of Water as a diuretic, digitalis, purgatives, iron--Antimony--Acupunc- ture--Treatment of head-symptoms and of inflammatory complications Cases illustrating treatment. 84 CHAPTER VII. PATHOLOGY OF GRANULAR DEGENERATION. Significance of the granular surface- Early stage of granular degeneration--Ad- vanced stage--Alterations in appearance of 0rgan-Changes in interstitial tissue, With consequent alterations in tubes, malpighian bodies. and epithelial cells--Cysts-Renal blood-vessels obstructed--Extra-renal Vascular changes_ Vies of Guull and Sutton. 94 cHAPTER VIII. CLINICAL HISTORY OF GRANULAR DEGENERATION, Sex anti age of its subjects--Causes and antecedents--Unconnected with tubercle --Climatic predisposition-Heredity--Gout, lead and alcohol--Valvular dis- ease of heart; example of this origin of the renal disorder--Pregnancy; in- stances of renal disease produced thereby--Scarlatina intermittent fever, re- tention of urine and general fibrosis as causes of granular degeneration. 105 CHAPTER IX. SYMPTOMS OF GRANULAR DEGENERATION OF THE KIDNEY. Insidious beginning-Change of complexion-Early signs--Signs of more advanced disease--Dyspepsia--Dropsy--Mental depression-Uraemic asthma-Hemor- rhagic attacks, apoplexy, retinal hemorrhage --Intlammatory complications; ulceration of bowel--Cerebral uremia--Tableb of symptoms --Urine: its gen- eral microscopic and Chemical characters--Cases illustrating the. progress and complications of the disease. 126 CHAPTER X. TREATMENT OF GRANULAR DEGENERATION. Capable of alleviation though not of cure--Change of climate--Use of Turkish and vapor baths-Of purgatives--Iron-Food and drink--Treatment of dropsy by iron, diuretics, purging, sweating, and puncture--Of dyspepsia and vomit- ing--Of uraemic head-symptoms--Intolerance of opium--Treatment of inflam- ` matory attacks, of renal asthma, of laryngeal oedema, of apoplexy, and of epistaxis--Induction of premature labor--Cases illustrating therapeutical points. 157 CHAPTER X1. PATHOLOGY OF THE LARDACEUs DISEASE. Organic change variously designated--Widely distributed--Parts affected--Depo- sition of new material detected by reaction of iodine--Situations and charac- ters of deposit--Resembles dealkalized fibrin--Mineral constituents of affected organs--Organic enlargement contrasted with that of rickets -Artificial pro- duction of lardaceous reaction--The two causes of the disease, suppuration and syphilis, considered--Morbid anatomy with reference to the kidneys- General changes; reaction of iodine-Association with interstitial fibrosis, changes in tubes, development of cysts--Connection between pathology and : Symptoms.167 CHAPTER XII CLINICAL HISTORY AND SYPTOMS OF LARDACEOUS DISEASE OF THE KIDNEY. Sex and age of subjects--Disorder easy of recognition when antecedents are ap- parent--Access of symptoms--Course slow, sometimes latent-Polyuria, thirst, dropsy --İnflammatory complications -- Diarrhoea and vomiting -- Cerebral uraemia-Causes of death--Cardio-vascular changes--Hemorrhagic attacks- Endocarditis--Table of symptoms-Characters of urine, general, microscopic, and chemical--Cases illustrating Origin and course and surgical aspects of the disease. 188 CHAPTER XIII TREATMENT OF THE LARDACEOUS DISEASE. Preventive--Arrest of suppuration--Medical aspect of surgical operations--Com- pensative treatment of suppuration--Curative measures--Iodide of potassium --Potash--Treatment of symptoms; of dropsy ; of uraemic attacks ; of di- arrhoea, etc.--Cases illustrative of treatment. 212 CHAPTER XIV. ON THE CONDITION OF THE HEART AND ARTERIES IN CHRONIC RENAL DISEASE. Views of Bright, of Johnson, of Gull and Sutton--Morbid anatomy of thickened arteries--Distribution of ventricular hypertrophy--Appeal to the pathology of childhood, With instances of cardio-vascular change in many circumstances of early renal disease,CONTEINTS. CHAPTER I. INTRODUCTORY. Structure of kidney-Its post-mortem state in health--Tables showing appear- ances presented by tubes and epithelium in sixty-five healthy kidneys--Fatty degeration of epithelim--Normal appearances of the epithelium, tubes, fibrous tissue, and blood-vessels--Changes which may be taken as signs of diseanse --Classiification of renal disease-Disease of the tubes, or tubal nephri- tis, sometimes intertubally complicated ; of the fibrous tissue or granular de- generation; of the blood and blood-vessels, or lardaceous change. 1 CHAPTER II. ALBUMINOUS URINE AND FIBRINOUS CASTS IN THEIR GENERAL RELATION TO THE PATHOLOGY OF THE KIDNEY. Albuminuria from state of blood-From alterations in the kidney--Transudation of serum, caused by renal congestion, by peculiar alteration in renal Vessels, or by loss to the tubes of their epithelial lining-Fibrinous casts derived like albumen from the liquor sanguinis--Their varieties and indications. 11 CHAPTER III. PATHOLOGY or. NEPHRİTIS. Change often limited to tubes --Acute form, congested kidney, changes evident to naked eye and With the mioroscope --More chronic variety, large white kid- ney, similarly considered--Obstruotion of tubes--Frequent participation of the interstitial tissue in the--inflammatory process--Fatty degeneration--Renal results of nephritis summarized--Mode of examining kidney with the microscope 16 CHAPTER IV. CLINICAL HISTORY AND SYMPTOMS OF NEPHRITIS. Sex and age of subjects--Causes--Symptoms--Dropsy, laryngeal oedema, infilam- matory and uraemic attacks-Symptoms in children and adults compared-- Tendency to recovery--Duration of disease-Causes of death--Tabular an- alysis of symptoms--Urine; its general microscopical and chemical charac- ters--Cases illustrating natural history of disease 27 CHAPTER V. CAUSES OF NEPHRITIS CONSIDERED IN DETAIL Cold-Circumstances in which nephritis thence arises ; temperate climate predis posing cause; Arctic experiences--Relation of nervous system to inflammation of kidney--Cases of nephritis produced by exposure, in one of which rupture of kidney occurred--Scarlatina as cause of renal disease; resultant organic changes; cases illustrating symptoms and pathology of scarlatinal dropsy-- Other febrile disorders as causes of nephritis--Instance of the origin of the disorder in acute rheumatism-Irritants foreign to the system as causes of renal inflammation; toxic albuminuria. 52 CHAPTER VI. TREATMENT OF NEPHRITIS. Methods pursued by Bright, Christison, Prout, Todd, Johnson, Bence Jones, etc. --General consideration of principles and details of treatment : blood-letting, use of Water as a diuretic, digitalis, purgatives, iron--Antimony--Acupunc- ture--Treatment of head-symptoms and of inflammatory complications Cases illustrating treatment. 84 CHAPTER VII. PATHOLOGY OF GRANULAR DEGENERATION. Significance of the granular surface- Early stage of granular degeneration--Ad- vanced stage--Alterations in appearance of 0rgan-Changes in interstitial tissue, With consequent alterations in tubes, malpighian bodies. and epithelial cells--Cysts-Renal blood-vessels obstructed--Extra-renal Vascular changes_ Vies of Guull and Sutton. 94 cHAPTER VIII. CLINICAL HISTORY OF GRANULAR DEGENERATION, Sex anti age of its subjects--Causes and antecedents--Unconnected with tubercle --Climatic predisposition-Heredity--Gout, lead and alcohol--Valvular dis- ease of heart; example of this origin of the renal disorder--Pregnancy; in- stances of renal disease produced thereby--Scarlatina intermittent fever, re- tention of urine and general fibrosis as causes of granular degeneration. 105 CHAPTER IX. SYMPTOMS OF GRANULAR DEGENERATION OF THE KIDNEY. Insidious beginning-Change of complexion-Early signs--Signs of more advanced disease--Dyspepsia--Dropsy--Mental depression-Uraemic asthma-Hemor- rhagic attacks, apoplexy, retinal hemorrhage --Intlammatory complications; ulceration of bowel--Cerebral uremia--Tableb of symptoms --Urine: its gen- eral microscopic and Chemical characters--Cases illustrating the. progress and complications of the disease. 126 CHAPTER X. TREATMENT OF GRANULAR DEGENERATION. Capable of alleviation though not of cure--Change of climate--Use of Turkish and vapor baths-Of purgatives--Iron-Food and drink--Treatment of dropsy by iron, diuretics, purging, sweating, and puncture--Of dyspepsia and vomit- ing--Of uraemic head-symptoms--Intolerance of opium--Treatment of inflam- ` matory attacks, of renal asthma, of laryngeal oedema, of apoplexy, and of epistaxis--Induction of premature labor--Cases illustrating therapeutical points. 157 CHAPTER X1. PATHOLOGY OF THE LARDACEUs DISEASE. Organic change variously designated--Widely distributed--Parts affected--Depo- sition of new material detected by reaction of iodine--Situations and charac- ters of deposit--Resembles dealkalized fibrin--Mineral constituents of affected organs--Organic enlargement contrasted with that of rickets -Artificial pro- duction of lardaceous reaction--The two causes of the disease, suppuration and syphilis, considered--Morbid anatomy with reference to the kidneys- General changes; reaction of iodine-Association with interstitial fibrosis, changes in tubes, development of cysts--Connection between pathology and : Symptoms.167 CHAPTER XII CLINICAL HISTORY AND SYPTOMS OF LARDACEOUS DISEASE OF THE KIDNEY. Sex and age of subjects--Disorder easy of recognition when antecedents are ap- parent--Access of symptoms--Course slow, sometimes latent-Polyuria, thirst, dropsy --İnflammatory complications -- Diarrhoea and vomiting -- Cerebral uraemia-Causes of death--Cardio-vascular changes--Hemorrhagic attacks- Endocarditis--Table of symptoms-Characters of urine, general, microscopic, and chemical--Cases illustrating Origin and course and surgical aspects of the disease. 188 CHAPTER XIII TREATMENT OF THE LARDACEOUS DISEASE. Preventive--Arrest of suppuration--Medical aspect of surgical operations--Com- pensative treatment of suppuration--Curative measures--Iodide of potassium --Potash--Treatment of symptoms; of dropsy ; of uraemic attacks ; of di- arrhoea, etc.--Cases illustrative of treatment. 212 CHAPTER XIV. ON THE CONDITION OF THE HEART AND ARTERIES IN CHRONIC RENAL DISEASE. Views of Bright, of Johnson, of Gull and Sutton--Morbid anatomy of thickened arteries--Distribution of ventricular hypertrophy--Appeal to the pathology of childhood, With instances of cardio-vascular change in many circumstances of early renal disease, and inferences therefrom-Results of destruction of renal substance by calculous disease--Evidence of sphygmograph--General conclusions. 223 CHAPTER XV. ON THE RETINAL CHANGES COMMON TO ALBUMINURIA. Passing blindness of CONTEINTS. CHAPTER I. INTRODUCTORY. Structure of kidney-Its post-mortem state in health--Tables showing appear- ances presented by tubes and epithelium in sixty-five healthy kidneys--Fatty degeration of epithelim--Normal appearances of the epithelium, tubes, fibrous tissue, and blood-vessels--Changes which may be taken as signs of diseanse --Classiification of renal disease-Disease of the tubes, or tubal nephri- tis, sometimes intertubally complicated ; of the fibrous tissue or granular de- generation; of the blood and blood-vessels, or lardaceous change. 1 CHAPTER II. ALBUMINOUS URINE AND FIBRINOUS CASTS IN THEIR GENERAL RELATION TO THE PATHOLOGY OF THE KIDNEY. Albuminuria from state of blood-From alterations in the kidney--Transudation of serum, caused by renal congestion, by peculiar alteration in renal Vessels, or by loss to the tubes of their epithelial lining-Fibrinous casts derived like albumen from the liquor sanguinis--Their varieties and indications. 11 CHAPTER III. PATHOLOGY or. NEPHRİTIS. Change often limited to tubes --Acute form, congested kidney, changes evident to naked eye and With the mioroscope --More chronic variety, large white kid- ney, similarly considered--Obstruotion of tubes--Frequent participation of the interstitial tissue in the--inflammatory process--Fatty degeneration--Renal results of nephritis summarized--Mode of examining kidney with the microscope 16 CHAPTER IV. CLINICAL HISTORY AND SYMPTOMS OF NEPHRITIS. Sex and age of subjects--Causes--Symptoms--Dropsy, laryngeal oedema, infilam- matory and uraemic attacks-Symptoms in children and adults compared-- Tendency to recovery--Duration of disease-Causes of death--Tabular an- alysis of symptoms--Urine; its general microscopical and chemical charac- ters--Cases illustrating natural history of disease 27 CHAPTER V. CAUSES OF NEPHRITIS CONSIDERED IN DETAIL Cold-Circumstances in which nephritis thence arises ; temperate climate predis posing cause; Arctic experiences--Relation of nervous system to inflammation of kidney--Cases of nephritis produced by exposure, in one of which rupture of kidney occurred--Scarlatina as cause of renal disease; resultant organic changes; cases illustrating symptoms and pathology of scarlatinal dropsy-- Other febrile disorders as causes of nephritis--Instance of the origin of the disorder in acute rheumatism-Irritants foreign to the system as causes of renal inflammation; toxic albuminuria. 52 CHAPTER VI. TREATMENT OF NEPHRITIS. Methods pursued by Bright, Christison, Prout, Todd, Johnson, Bence Jones, etc. --General consideration of principles and details of treatment : blood-letting, use of Water as a diuretic, digitalis, purgatives, iron--Antimony--Acupunc- ture--Treatment of head-symptoms and of inflammatory complications Cases illustrating treatment. 84 CHAPTER VII. PATHOLOGY OF GRANULAR DEGENERATION. Significance of the granular surface- Early stage of granular degeneration--Ad- vanced stage--Alterations in appearance of 0rgan-Changes in interstitial tissue, With consequent alterations in tubes, malpighian bodies. and epithelial cells--Cysts-Renal blood-vessels obstructed--Extra-renal Vascular changes_ Vies of Guull and Sutton. 94 cHAPTER VIII. CLINICAL HISTORY OF GRANULAR DEGENERATION, Sex anti age of its subjects--Causes and antecedents--Unconnected with tubercle --Climatic predisposition-Heredity--Gout, lead and alcohol--Valvular dis- ease of heart; example of this origin of the renal disorder--Pregnancy; in- stances of renal disease produced thereby--Scarlatina intermittent fever, re- tention of urine and general fibrosis as causes of granular degeneration. 105 CHAPTER IX. SYMPTOMS OF GRANULAR DEGENERATION OF THE KIDNEY. Insidious beginning-Change of complexion-Early signs--Signs of more advanced disease--Dyspepsia--Dropsy--Mental depression-Uraemic asthma-Hemor- rhagic attacks, apoplexy, retinal hemorrhage --Intlammatory complications; ulceration of bowel--Cerebral uremia--Tableb of symptoms --Urine: its gen- eral microscopic and Chemical characters--Cases illustrating the. progress and complications of the disease. 126 CHAPTER X. TREATMENT OF GRANULAR DEGENERATION. Capable of alleviation though not of cure--Change of climate--Use of Turkish and vapor baths-Of purgatives--Iron-Food and drink--Treatment of dropsy by iron, diuretics, purging, sweating, and puncture--Of dyspepsia and vomit- ing--Of uraemic head-symptoms--Intolerance of opium--Treatment of inflam- ` matory attacks, of renal asthma, of laryngeal oedema, of apoplexy, and of epistaxis--Induction of premature labor--Cases illustrating therapeutical points. 157 CHAPTER X1. PATHOLOGY OF THE LARDACEUs DISEASE. Organic change variously designated--Widely distributed--Parts affected--Depo- sition of new material detected by reaction of iodine--Situations and charac- ters of deposit--Resembles dealkalized fibrin--Mineral constituents of affected organs--Organic enlargement contrasted with that of rickets -Artificial pro- duction of lardaceous reaction--The two causes of the disease, suppuration and syphilis, considered--Morbid anatomy with reference to the kidneys- General changes; reaction of iodine-Association with interstitial fibrosis, changes in tubes, development of cysts--Connection between pathology and : Symptoms.167 CHAPTER XII CLINICAL HISTORY AND SYPTOMS OF LARDACEOUS DISEASE OF THE KIDNEY. Sex and age of subjects--Disorder easy of recognition when antecedents are ap- parent--Access of symptoms--Course slow, sometimes latent-Polyuria, thirst, dropsy --İnflammatory complications -- Diarrhoea and vomiting -- Cerebral uraemia-Causes of death--Cardio-vascular changes--Hemorrhagic attacks- Endocarditis--Table of symptoms-Characters of urine, general, microscopic, and chemical--Cases illustrating Origin and course and surgical aspects of the disease. 188 CHAPTER XIII TREATMENT OF THE LARDACEOUS DISEASE. Preventive--Arrest of suppuration--Medical aspect of surgical operations--Com- pensative treatment of suppuration--Curative measures--Iodide of potassium --Potash--Treatment of symptoms; of dropsy ; of uraemic attacks ; of di- arrhoea, etc.--Cases illustrative of treatment. 212 CHAPTER XIV. ON THE CONDITION OF THE HEART AND ARTERIES IN CHRONIC RENAL DISEASE. Views of Bright, of Johnson, of Gull and Sutton--Morbid anatomy of thickened arteries--Distribution of ventricular hypertrophy--Appeal to the pathology of childhood, With instances of cardio-vascular change in many circumstances of early renal disease, and inferences therefrom-Results of destruction of renal substance by calculous disease--Evidence of sphygmograph--General conclusions. 223 CHAPTER XV. ON THE RETINAL CHANGES COMMON TO ALBUMINURIA. Passing blindness of uraemic origin-Retinal changes, oedema, hemorrhage, white spots--Post-mortem appearances of eye--Disturbances of vision--Treatment of retinal disorder--Its distribution in relation to the several forms of renal disease. 244 CHAPTER XVI. THE BLOOD IN ALBUMINURCONTEINTS. CHAPTER I. INTRODUCTORY. Structure of kidney-Its post-mortem state in health--Tables showing appear- ances presented by tubes and epithelium in sixty-five healthy kidneys--Fatty degeration of epithelim--Normal appearances of the epithelium, tubes, fibrous tissue, and blood-vessels--Changes which may be taken as signs of diseanse --Classiification of renal disease-Disease of the tubes, or tubal nephri- tis, sometimes intertubally complicated ; of the fibrous tissue or granular de- generation; of the blood and blood-vessels, or lardaceous change. 1 CHAPTER II. ALBUMINOUS URINE AND FIBRINOUS CASTS IN THEIR GENERAL RELATION TO THE PATHOLOGY OF THE KIDNEY. Albuminuria from state of blood-From alterations in the kidney--Transudation of serum, caused by renal congestion, by peculiar alteration in renal Vessels, or by loss to the tubes of their epithelial lining-Fibrinous casts derived like albumen from the liquor sanguinis--Their varieties and indications. 11 CHAPTER III. PATHOLOGY or. NEPHRİTIS. Change often limited to tubes --Acute form, congested kidney, changes evident to naked eye and With the mioroscope --More chronic variety, large white kid- ney, similarly considered--Obstruotion of tubes--Frequent participation of the interstitial tissue in the--inflammatory process--Fatty degeneration--Renal results of nephritis summarized--Mode of examining kidney with the microscope 16 CHAPTER IV. CLINICAL HISTORY AND SYMPTOMS OF NEPHRITIS. Sex and age of subjects--Causes--Symptoms--Dropsy, laryngeal oedema, infilam- matory and uraemic attacks-Symptoms in children and adults compared-- Tendency to recovery--Duration of disease-Causes of death--Tabular an- alysis of symptoms--Urine; its general microscopical and chemical charac- ters--Cases illustrating natural history of disease 27 CHAPTER V. CAUSES OF NEPHRITIS CONSIDERED IN DETAIL Cold-Circumstances in which nephritis thence arises ; temperate climate predis posing cause; Arctic experiences--Relation of nervous system to inflammation of kidney--Cases of nephritis produced by exposure, in one of which rupture of kidney occurred--Scarlatina as cause of renal disease; resultant organic changes; cases illustrating symptoms and pathology of scarlatinal dropsy-- Other febrile disorders as causes of nephritis--Instance of the origin of the disorder in acute rheumatism-Irritants foreign to the system as causes of renal inflammation; toxic albuminuria. 52 CHAPTER VI. TREATMENT OF NEPHRITIS. Methods pursued by Bright, Christison, Prout, Todd, Johnson, Bence Jones, etc. --General consideration of principles and details of treatment : blood-letting, use of Water as a diuretic, digitalis, purgatives, iron--Antimony--Acupunc- ture--Treatment of head-symptoms and of inflammatory complications Cases illustrating treatment. 84 CHAPTER VII. PATHOLOGY OF GRANULAR DEGENERATION. Significance of the granular surface- Early stage of granular degeneration--Ad- vanced stage--Alterations in appearance of 0rgan-Changes in interstitial tissue, With consequent alterations in tubes, malpighian bodies. and epithelial cells--Cysts-Renal blood-vessels obstructed--Extra-renal Vascular changes_ Vies of Guull and Sutton. 94 cHAPTER VIII. CLINICAL HISTORY OF GRANULAR DEGENERATION, Sex anti age of its subjects--Causes and antecedents--Unconnected with tubercle --Climatic predisposition-Heredity--Gout, lead and alcohol--Valvular dis- ease of heart; example of this origin of the renal disorder--Pregnancy; in- stances of renal disease produced thereby--Scarlatina intermittent fever, re- tention of urine and general fibrosis as causes of granular degeneration. 105 CHAPTER IX. SYMPTOMS OF GRANULAR DEGENERATION OF THE KIDNEY. Insidious beginning-Change of complexion-Early signs--Signs of more advanced disease--Dyspepsia--Dropsy--Mental depression-Uraemic asthma-Hemor- rhagic attacks, apoplexy, retinal hemorrhage --Intlammatory complications; ulceration of bowel--Cerebral uremia--Tableb of symptoms --Urine: its gen- eral microscopic and Chemical characters--Cases illustrating the. progress and complications of the disease. 126 CHAPTER X. TREATMENT OF GRANULAR DEGENERATION. Capable of alleviation though not of cure--Change of climate--Use of Turkish and vapor baths-Of purgatives--Iron-Food and drink--Treatment of dropsy by iron, diuretics, purging, sweating, and puncture--Of dyspepsia and vomit- ing--Of uraemic head-symptoms--Intolerance of opium--Treatment of inflam- ` matory attacks, of renal asthma, of laryngeal oedema, of apoplexy, and of epistaxis--Induction of premature labor--Cases illustrating therapeutical points. 157 CHAPTER X1. PATHOLOGY OF THE LARDACEUsCONTEINTS. CHAPTER I. INTRODUCTORY. Structure of kidney-Its post-mortem state in health--Tables showing appear- ances presented by tubes and epithelium in sixty-five healthy kidneys--Fatty degeration of epithelim--Normal appearances of the epithelium, tubes, fibrous tissue, and blood-vessels--Changes which may be taken as signs of diseanse --Classiification of renal disease-Disease of the tubes, or tubal nephri- tis, sometimes intertubally complicated ; of the fibrous tissue or granular de- generation; of the blood and blood-vessels, or lardaceous change. 1 CHAPTER II. ALBUMINOUS URINE AND FIBRINOUS CASTS IN THEIR GENERAL RELATION TO THE PATHOLOGY OF THE KIDNEY. Albuminuria from state of blood-From alterations in the kidney--Transudation of serum, caused by renal congestion, by peculiar alteration in renal Vessels, or by loss to the tubes of their epithelial lining-Fibrinous casts derived like albumen from the liquor sanguinis--Their varieties and indications. 11 CHAPTER III. PATHOLOGY or. NEPHRİTIS. Change often limited to tubes --Acute form, congested kidney, changes evident to naked eye and With the mioroscope --More chronic variety, large white kid- ney, similarly considered--Obstruotion of tubes--Frequent participation of the interstitial tissue in the--inflammatory process--Fatty degeneration--Renal results of nephritis summarized--Mode of examining kidney with the microscope 16 CHAPTER IV. CLINICAL HISTORY AND SYMPTOMS OF NEPHRITIS. Sex and age of subjects--Causes--Symptoms--Dropsy, laryngeal oedema, infilam- matory and uraemic attacks-Symptoms in children and adults compared-- Tendency to recovery--Duration of disease-Causes of death--Tabular an- alysis of symptoms--Urine; its general microscopical and chemical charac- ters--Cases illustrating natural history of disease 27 CHAPTER V. CAUSES OF NEPHRITIS CONSIDERED IN DETAIL Cold-Circumstances in which nephritis thence arises ; temperate climate predis posing cause; Arctic experiences--Relation of nervous system to inflammation of kidney--Cases of nephritis produced by exposure, in one of which rupture of kidney occurred--Scarlatina as cause of renal disease; resultant organic changes; cases illustrating symptoms and pathology of scarlatinal dropsy-- Other febrile disorders as causes of nephritis--Instance of the origin of the disorder in acute rheumatism-Irritants foreign to the system as causes of renal inflammation; toxic albuminuria. 52 CHAPTER VI. TREATMENT OF NEPHRITIS. Methods pursued by Bright, Christison, Prout, Todd, Johnson, Bence Jones, etc. --General consideration of principles and details of treatment : blood-letting, use of Water as a diuretic, digitalis, purgatives, iron--Antimony--Acupunc- ture--Treatment of head-symptoms and of inflammatory complications Cases illustrating treatment. 84 CHAPTER VII. PATHOLOGY OF GRANULAR DEGENERATION. Significance of the granular surface- Early stage of granular degeneration--Ad- vanced stage--Alterations in appearance of 0rgan-Changes in interstitial tissue, With consequent alterations in tubes, malpighian bodies. and epithelial cells--Cysts-Renal blood-vessels obstructed--Extra-renal Vascular changes_ Vies of Guull and Sutton. 94 cHAPTER VIII. CLINICAL HISTORY OF GRANULAR DEGENERATION, Sex anti age of its subjects--Causes and antecedents--Unconnected with tubercle --Climatic predisposition-Heredity--Gout, lead and alcohol--Valvular dis- ease of heart; example of this origin of the renal disorder--Pregnancy; in- stances of renal disease produced thereby--Scarlatina intermittent fever, re- tention of urine and general fibrosis as causes of granular degeneration. 105 CHAPTER IX. SYMPTOMS OF GRANULAR DEGENERATION OF THE KIDNEY. Insidious beginning-Change of complexion-Early signs--Signs of more advanced disease--Dyspepsia--Dropsy--Mental depression-Uraemic asthma-Hemor- rhagic attacks, apoplexy, retinal hemorrhage --Intlammatory complications; ulceration of bowel--Cerebral uremia--Tableb of symptoms --Urine: its gen- eral microscopic and Chemical characters--Cases illustrating the. progress and complications of the disease. 126 CHAPTER X. TREATMENT OF GRANULAR DEGENERATION. Capable of alleviation though not of cure--Change of climate--Use of Turkish and vapor baths-Of purgatives--Iron-Food and drink--Treatment of dropsy by iron, diuretics, purging, sweating, and puncture--Of dyspepsia and vomit- ing--Of uraemic head-symptoms--Intolerance of opium--Treatment of inflam- ` matory attacks, of renal asthma, of laryngeal oedema, of apoplexy, and of epistaxis--Induction of premature labor--Cases illustrating therapeutical points. 157 CHAPTER X1. PATHOLOGY OF THE LARDACEUs DISEASE. Organic change variously designated--Widely distributed--Parts affected--Depo- sition of new material detected by reaction of iodine--Situations and charac- ters of deposit--Resembles dealkalized fibrin--Mineral constituents of affected organs--Organic enlargement contrasted with that of rickets -Artificial pro- duction of lardaceous reaction--The two causes of the disease, suppuration and syphilis, considered--Morbid anatomy with reference to the kidneys- General changes; reaction of iodine-Association with interstitial fibrosis, changes in tubes, development of cysts--Connection between pathology and : Symptoms.167 CHAPTER XII CLINICAL HISTORY AND SYPTOMS OF LARDACEOUS DISEASE OF THE KIDNEY. Sex and age of subjects--Disorder easy of recognition when antecedents are ap- parent--Access of symptoms--Course slow, sometimes latent-Polyuria, thirst, dropsy --İnflammatory complications -- Diarrhoea and vomiting -- Cerebral uraemia-Causes of death--Cardio-vascular changes--Hemorrhagic attacks- Endocarditis--Table of symptoms-Characters of urine, general, microscopic, and chemical--Cases illustrating Origin and course and surgical aspects of the disease. 188 CHAPTER XIII TREATMENT OF THE LARDACEOUS DISEASE. Preventive--Arrest of suppuration--Medical aspect of surgical operations--Com- pensative treatment of suppuration--Curative measures--Iodide of potassium --Potash--Treatment of symptoms; of dropsy ; of uraemic attacks ; of di- arrhoea, etc.--Cases illustrative of treatment. 212 CHAPTER XIV. ON THE CONDITION OF THE HEART AND ARTERIES IN CHRONIC RENAL DISEASE. Views of Bright, of Johnson, of Gull and Sutton--Morbid anatomy of thickened arteries--Distribution of ventricular hypertrophy--Appeal to the pathology of childhood, With instances of cardio-vascular change in many circumstances of early renal disease, and inferences therefrom-Results of destruction of renal substance by calculous disease--Evidence of sphygmograph--General conclusions. 223 CHAPTER XV. ON THE RETINAL CHANGES COMMON TO ALBUMINURIA. Passing blindness of uraemic origin-Retinal changes, oedema, hemorrhage, white spots--Post-mortem appearances of eye--Disturbances of vision--Treatment of retinal disorder--Its distribution in relation to the several forms of renal disease. 244 CHAPTER XVI. THE BLOOD IN ALBUMINURIA General alterations--Changes observed in each disorder considered separately, With table of analyses--Numerical estimation of blood-corpuscles in each dis- ease, with details in a tabular form--General conclusions--Nature of uraemia. 250 CHAPTER XVII GENERAL COMPARISON ON THE THREE FORMS OF RENAL DISEASE WHICH HAVE BEEN CONSIDERED. Age selected by each disorder--Diagram-Comparison of symptoms in each, with tables showing percentage of secondary affections. 265 CHAPTER XVIII. ALCOHOL AS A CAUSE OF RENAL DISEASE Sources of error--State of kidneys after death by delirium tremens; in persons employed in the liquor trade ; and in reputed drunkards--Inferences from pathological observation; liver and kidney differently affected by alcoholic drinks--Table showing distribution of renal disease in regard to local drink, intemperance, and occupation. 271 CHPTER XIX CLIMATE IN RELATION TO RENAL DISEASE. Sources of information--Prevalence of albuminuria and of syphilis among British troops at various stations, With particulars of climate--Mortality from renal disease in various cities of the world and in various counties of England and r Scotland-General prevalence of albuminuria in temperate climates, With ex- emption of moderately hot and extremely cold countries-Further details as to distribution of disease-Lardaceous disorder common in hot countries- Attempt to account for the prevalence of albuminuria in temperate climates --Variability of temperature and humidity causes of renal disease---Practical conclusions 280 INDEX 293 DISEASE. Organic change variously designated--Widely distributed--Parts affected--Depo- sition of new material detected by reaction of iodine--Situations and charac- ters of deposit--Resembles dealkalized fibrin--Mineral constituents of affected organs--Organic enlargement contrasted with that of rickets -Artificial pro- duction of lardaceous reaction--The two causes of the disease, suppuration and syphilis, considered--Morbid anatomy with reference to the kidneys- General changes; reaction of iodine-Association with interstitial fibrosis, changes in tubes, development of cysts--Connection between pathology and : Symptoms.167 CHAPTER XII CLINICAL HISTORY AND SYPTOMS OF LARDACEOUS DISEASE OF THE KIDNEY. Sex and age of subjects--Disorder easy of recognition when antecedents are ap- parent--Access of symptoms--Course slow, sometimes latent-Polyuria, thirst, dropsy --İnflammatory complications -- Diarrhoea and vomiting -- Cerebral uraemia-Causes of death--Cardio-vascular changes--Hemorrhagic attacks- Endocarditis--Table of symptoms-Characters of urine, general, microscopic, and chemical--Cases illustrating Origin and course and surgical aspects of the disease. 188 CHAPTER XIII TREATMENT OF THE LARDACEOUS DISEASE. Preventive--Arrest of suppuration--Medical aspect of surgical operations--Com- pensative treatment of suppuration--Curative measures--Iodide of potassium --Potash--Treatment of symptoms; of dropsy ; of uraemic attacks ; of di- arrhoea, etc.--Cases illustrative of treatment. 212 CHAPTER XIV. ON THE CONDITION OF THE HEART AND ARTERIES IN CHRONIC RENAL DISEASE. Views of Bright, of Johnson, of Gull and Sutton--Morbid anatomy of thickened arteries--Distribution of ventricular hypertrophy--Appeal to the pathology of childhood, With instances of cardio-vascular change in many circumstances of early renal disease, and inferences therefrom-Results of destruction of renal substance by calculous disease--Evidence of sphygmograph--General conclusions. 223 CHAPTER XV. ON THE RETINAL CHANGES COMMON TO ALBUMINURIA. Passing blindness of uraemic origin-Retinal changes, oedema, hemorrhage, white spots--Post-mortem appearances of eye--Disturbances of vision--Treatment of retinal disorder--Its distribution in relation to the several forms of renal disease. 244 CHAPTER XVI. THE BLOOD IN ALBUMINURIA General alterations--Changes observed in each disorder considered separately, With table of analyses--Numerical estimation of blood-corpuscles in each dis- ease, with details in a tabular form--General conclusions--Nature of uraemia. 250 CHAPTER XVII GENERAL COMPARISON ON THE THREE FORMS OF RENAL DISEASE WHICH HAVE BEEN CONSIDERED. Age selected by each disorder--Diagram-Comparison of symptoms in each, with tables showing percentage of secondary affections. 265 CHAPTER XVIII. ALCOHOL AS A CAUSE OF RENAL DISEASE Sources of error--State of kidneys after death by delirium tremens; in persons employed in the liquor trade ; and in reputed drunkards--Inferences from pathological observation; liver and kidney differently affected by alcoholic drinks--Table showing distribution of renal disease in regard to local drink, intemperance, and occupation. 271 CHPTER XIX CLIMATE IN RELATION TO RENAL DISEASE. Sources of information--Prevalence of albuminuria and of syphilis among British troops at various stations, With particulars of climate--Mortality from renal disease in various cities of the world and in various counties of England and r Scotland-General prevalence of albuminuria in temperate climates, With ex- emption of moderately hot and extremely cold countries-Further details as to distribution of disease-Lardaceous disorder common in hot countries- Attempt to account for the prevalence of albuminuria in temperate climates --Variability of temperature and humidity causes of renal disease---Practical conclusions 280 INDEX 293IA General alterations--Changes observed in each disorder considered separately, With table of analyses--Numerical estimation of blood-corpuscles in each dis- ease, with details in a tabular form--General conclusions--Nature of uraemia. 250 CHAPTER XVII GENERAL COMPARISON ON THE THREE FORMS OF RENAL DISEASE WHICH HAVE BEEN CONSIDERED. Age selected by each disorder--Diagram-Comparison of symptoms in each, with tables showing percentage of secondary affections. 265 CHAPTER XVIII. ALCOHOL AS A CAUSE OF RENAL DISEASE Sources of error--State of kidneys after death by delirium tremens; in persons employed in the liquor trade ; and in reputed drunkards--Inferences from pathological observation; liver and kidney differently affected by alcoholic drinks--Table showing distribution of renal disease in regard to local drink, intemperance, and occupation. 271 CHPTER XIX CLIMATE IN RELATION TO RENAL DISEASE. Sources of information--Prevalence of albuminuria and of syphilis among British troops at various stations, With particulars of climate--Mortality from renal disease in various cities of the world and in various counties of England and r Scotland-General prevalence of albuminuria in temperate climates, With ex- emption of moderately hot and extremely cold countries-Further details as to distribution of disease-Lardaceous disorder common in hot countries- Attempt to account for the prevalence of albuminuria in temperate climates --Variability of temperature and humidity causes of renal disease---Practical conclusions 280 INDEX 293uraemic origin-Retinal changes, oedema, hemorrhage, white spots--Post-mortem appearances of eye--Disturbances of vision--Treatment of retinal disorder--Its distribution in relation to the several forms of renal disease. 244 CHAPTER XVI. THE BLOOD IN ALBUMINURIA General alterations--Changes observed in each disorder considered separately, With table of analyses--Numerical estimation of blood-corpuscles in each dis- ease, with details in a tabular form--General conclusions--Nature of uraemia. 250 CHAPTER XVII GENERAL COMPARISON ON THE THREE FORMS OF RENAL DISEASE WHICH HAVE BEEN CONSIDERED. Age selected by each disorder--Diagram-Comparison of symptoms in each, with tables showing percentage of secondary affections. 265 CHAPTER XVIII. ALCOHOL AS A CAUSE OF RENAL DISEASE Sources of error--State of kidneys after death by delirium tremens; in persons employed in the liquor trade ; and in reputed drunkards--Inferences from pathological observation; liver and kidney differently affected by alcoholic drinks--Table showing distribution of renal disease in regard to local drink, intemperance, and occupation. 271 CHPTER XIX CLIMATE IN RELATION TO RENAL DISEASE. Sources of information--Prevalence of albuminuria and of syphilis among British troops at various stations, With particulars of climate--Mortality from renal disease in various cities of the world and in various counties of England and r Scotland-General prevalence of albuminuria in temperate climates, With ex- emption of moderately hot and extremely cold countries-Further details as to distribution of disease-Lardaceous disorder common in hot countries- Attempt to account for the prevalence of albuminuria in temperate climates --Variability of temperature and humidity causes of renal disease---Practical conclusions 280 INDEX 293 and inferences therefrom-Results of destruction of renal substance by calculous disease--Evidence of sphygmograph--General conclusions. 223 CHAPTER XV. ON THE RETINAL CHANGES COMMON TO ALBUMINURIA. Passing blindness of uraemic origin-Retinal changes, oedema, hemorrhage, white spots--Post-mortem appearances of eye--Disturbances of vision--Treatment of retinal disorder--Its distribution in relation to the several forms of renal disease. 244 CHAPTER XVI. THE BLOOD IN ALBUMINURIA General alterations--Changes observed in each disorder considered separately, With table of analyses--Numerical estimation of blood-corpuscles in each dis- ease, with details in a tabular form--General conclusions--Nature of uraemia. 250 CHAPTER XVII GENERAL COMPARISON ON THE THREE FORMS OF RENAL DISEASE WHICH HAVE BEEN CONSIDERED. Age selected by each disorder--Diagram-Comparison of symptoms in each, with tables showing percentage of secondary affections. 265 CHAPTER XVIII. ALCOHOL AS A CAUSE OF RENAL DISEASE Sources of error--State of kidneys after death by delirium tremens; in persons employed in the liquor trade ; and in reputed drunkards--Inferences from pathological observation; liver and kidney differently affected by alcoholic drinks--Table showing distribution of renal disease in regard to local drink, intemperance, and occupation. 271 CHPTER XIX CLIMATE IN RELATION TO RENAL DISEASE. Sources of information--Prevalence of albuminuria and of syphilis among British troops at various stations, With particulars of climate--Mortality from renal disease in various cities of the world and in various counties of England and r Scotland-General prevalence of albuminuria in temperate climates, With ex- emption of moderately hot and extremely cold countries-Further details as to distribution of disease-Lardaceous disorder common in hot countries- Attempt to account for the prevalence of albuminuria in temperate climates --Variability of temperature and humidity causes of renal disease---Practical conclusions 280 INDEX 293  |
