A paper on renal dropsy : illustrated by cases and a dissection ... / by John Anderson.

Date:
1835
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Licence: Public Domain Mark

Credit: A paper on renal dropsy : illustrated by cases and a dissection ... / by John Anderson. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    (•> nitric acid. The syrup from the effused fluid of the brain, as also that of the ab- domen, yielded within two hours a con- siderable crop of foliaceous pearly crys- tals, of an arborescent form. That from the pericardium, as also that from the pleura;, yielded a very small crop of crystals, after a much longer time. Dr. Barlow has strong' reasons for be- lieving that these crystals were nitrate of urea. The case just related, then, presents many particulars of practical interest and importance. 1st, The remote cause of his com- plaint—his intemperate habits, and con- sequent exposure to changes of tempe- rature ; perhaps, also, his predisposition to gout. The manner in which these debilitating- agents operate has .been fully explained previously. 2dly, The most prominent attendant symptoms. Of these, perhaps the pains in the head and loins were the most universal. The affection of the head, certainly, was not particularly well marked iu this case during its course; but it is generally of a very distressing character, and is described as either a lancinating, darting, throbbing pain, occurring more commonly in the fore part of the head, or a feeling of constric- tion and tightness, as if an iron hoop were bound round very firmly; it comes on generally towards evening, and re- laxes towards morning, going on in this way for some time, and then being ab- sent for days together; it is the symp- tom usually most complained of, and certainly the one most distressing to the feeling's of the patient. There are two Eatients now in the clinical wards who ave just this character of pain; and I have seen it in them almost unbearable. Its acuteness is owing most probably to the inflammatory tendency of the body g-enerally, and of the serous membranes in particular; perhaps also owing to the circulation of unhealthy blood. The pain in the loins was a well-marked symptom in this case; it was seated evi- dently in the kidney, and fully indicated the mischief going on there ; whilst the post-mortem account corroborated it. He had cough, dyspnoea, and slight bronchial affection (frequent though not necessary attendants), for which the morbid state of the lungs and their ad- hesions fully accounted. He had palpi- tation ; and the left ventricle of the heart was much hypcrtrophied. This morbid occurrence is of much interest and importance, and one to which I shall more particularly advert in the pathological remarks. With regard to the dropsical effusions, there were both ascites and anasarca. The existence of fluid in the cavity of the abdomen gave no sense of fluctua- tion during life, from the thickened cedematous state of the abdominal pa- rietes. This form of effusion, in con- nexion with albuminous urine, is not of frequent occurrence. From the observa- tions of Drs. Wells, Christison, Gre- gory, and Bright*, anasarca, local or general, appears to be much more inti- mately connected with this morbid state of kidney and urine. Iu this case, the tendency to anasarca was very great, it being almost general. Sometimes this affection is only very slight, and there are cases now in the hospital where it is confined to the ankles only (and these scarcely pitting on pressure), or to the face, giving it a bloated, sallow, puffy appearance. This latter is a very characteristic sign, and will often detect the disease. With re- gard to the oedema of the face, this is sometimes very great, and particularly so early in the morning; the eyelids and cellular membrane, more especially in the direction and extent of the orbiculares palpebrarum, are puffed, sometimes so as to completely obstruct vision. Imperfectuess of vision also oc- curs from another mechanical cause, viz. effusion of serum between some of the membranes of the eye ; but whether this is really the case, or whether the brain itself is in some way affected, is not, I believe, quite ascertained ; perhaps both causes may operate,—thougli in favour of the latter I have observed, that when the tendency to head affection is greatest (independent of any cedema), and the paroxysms of pain before described are most violent, vision is decidedly most impaired; and also that the power of vision has improved simultaneously with thecessation oftheparoxysms,thoughthe oedema of the face and general anasarca may have remained the same ; and this latter affection I have sometimes, thougli not always, seen less where the head affection was the greatest. Now, sup- posing these pains to depend partly oil any inflammatory state of the mem- branes of the brain, may the greater • See the Cyclopaedia of Practical Medicine, article Dropsy, ». 641.