On the waxy or amyloid degeneration of the kidney : a communication read before the Medico-Chirurgical Society of Edinburgh / by T. Grainger Stewart.

  • Stewart, Thomas Grainger, 1837-1900.
Date:
1861
Catalogue details

Licence: Public Domain Mark

Credit: On the waxy or amyloid degeneration of the kidney : a communication read before the Medico-Chirurgical Society of Edinburgh / by T. Grainger Stewart. Source: Wellcome Collection.

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    amount of urine than was natural, and at the same time her ankles became oedematous, and her face at times puffy. Her weakness in¬ creasing, she applied for and obtained admission to the Infirmary. On admission, heart sounds healthy ; pulse 100, small and feeble. There was considerable harshness of respiratory murmurs all over the chest. Tongue clean, but rather dry; thirst great; appetite good ; bowels regular; slight ascites; the liver and spleen not en¬ larged ; legs slightly oedematous ; skin pale and dry. Urine was copious, about 50 to 70 oz. per diem ; sp. gr. 1005 ; containing much albumen and few chlorides. A sediment was deposited on standing, which contained numerous hyaline tubecasts, involving here and there a cell which had undergone fatty degeneration. Patient remained under observation without much change for two months, during which time her urine ranged from 50 to 120 oz. daily. On only two occasions during these two months did it fall below 50 oz. I repeatedly tested the casts with iodine and sul¬ phuric acid, but without ever producing a reddish-purple or blue colour. The ascites gradually increased. About the beginning of May she was seized with diarrhoea, with increased cough and dyspnoea, and with advancing dropsy of the legs and abdomen. The daily amount of urine fell to 30 or 40 oz., very albuminous, and containing casts with more fatty renal cells than formerly. She died exhausted on Mav 20th. On examination, the lungs were found free from tubercle, but the bronchi congested and full of mucus. Heart small, weighing less than 4 oz.; spleen large and waxy; liver large and waxy, weighing 1 lb. 15 oz.; kidneys large, weighing together 13i oz. The cortical substance was very pale, and distinctly presenting the characters of the waxy or amyloid degeneration, both in mass and when examined microscopically, and with the chemical reagents. There was no ulceration of the intestines. In this well-marked case it will be observed that there was a weakly constitution, with a constant, long-continued, purulent dis¬ charge from a carious bone, with increase of urine and gradually supervening dropsy. I shall now relate the history of another case which was for many weeks under observation in the Clinical Wards. Case II.—Anne Walker, set. 37, single, a bootbinder, resident in Edinburgh, admitted April 30, 1860. She states that for many years she has been accustomed to take alcoholic drinks in large quantity, and has been subject to rheumatism ; that three years ago she had rheumatic fever, and has since been subject to & short dry cough, with great debility, which has lately prevented her working. Ihree months ago she was seized with cramp in the legs, with pain in the lumbar and hepatic regions; and noticed that she had con¬ siderable thirst, and passed large quantities of urine—much more, she thinks, than she did on admission to the Infirmary. She soon noticed her feet swell, and afterwards her legs and abdomen, but without