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

Date:
1835
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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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    logy would justly indicate; and before these theories can be overturned, or these connexions and relations dis- roved, an equal mass of evidence must e brought into the scale, and pathology must l)e as intimately connected with an opposite train of reasoning, as in the cases just alluded to. I am quite cer- tain, that if this subject were not treat- ed so superficially by many, its impor- tance would be more evident; and from experiments, I am sure that the conti- nued appearance of albumen in the urine, unconnected with dropsical effu- sion, is by no means so constant an oc- currence as is usually supposed, but that connected with anasarca it very frequently takes place, and that when present it should always be an object of great anxiety, as indicative of extreme mischief and danger. It is this form of dropsy (to which Dr. Bright has sug- gested the name of renal) that I have ventured to select for the present discussion, illustrating it as far as pos- sible by cases that have recently oc- curred m this hospital, and more parti- cularly by one that proved fatal, and which we had an opportunity of investi- gating after death. Dropsical effusion, connected with al- buminous uiine, is induced by several causes, which predispose the kidney to suffer. 1st. Scarlatina.—In this case, the skin, from the previous eruption, is ren- dered very susceptible of cold, and its secretirig function very much impaired ; the kidneys sympathize, become func- tionally deranged, and serous effusion is the consequence. The urine will, in most cases, be found to be coagulable. Dr. Blackall relates about ten cases, illustrative of this, in five of which there was a bloody sediment in the urine. Dr. Hughes has found the urine albumi- nous in about twelve cases. Dr. Addi- son has frequently found it so, and fur- ther observes, that whenever this is the case, we may prognosticate anasarca *. This anasarca is truly of an inflamma- tory nature, generally coming on sud- denly, and when early and properly treated does well. Antiphlogistic reme- dies are to be employed, and great re- liance (according to Dr. Blackall) is to be placed on digitalis, the efficacy of which is fully shewn in the treatment of the above-mentioned cases; these are related at full length in his valuable • Dr. Addison's Lectures on Prnctice of Physic. treatise*. Dr. Wells also has given much valuable information on the na- ture and cure of this form of dropsical effusion f. Dr. Bright also observes, that it is almost always accompanied by an obvious derangement of the kid- neys, that the urine is frequently coa- gulable, and that there is more or less tendency to hiematuria +. 2dly. Abuse of mercury.—As to whe- ther mercury has the power of produc- ing a coagulum in the urine, and the propriety of its employment in renal cases,—on this I will observe hereafter, and shall merely now state that the ana- sarca arising from this cause is of a true inflammatory nature, and may come on either suddenly or gradually; the former being the most favourable. Antiphlo- gistic remedies are here requisite, and an immediate discontinuance of the mer- cury, supposing the patient to be under- going a course of it. In furtherance of this I may notice the case of a man now in Lazarus Ward, who had always en- joyed good health until attacked with syphilis some months ago, and took a considerable quantity of mercury: be- fore this time he never observed any swelling, but, shortly afterwards, his legs became anasarcous, and his urine very decidedly coagulable. Dr. Blackall also relates nine cases illustrative of this form of inflammatory anasarca, treated principally by antiphlogistic means. 3dly. Several other remote causes are given by Dr. Blackall, as gout, the improper exhibition of bark and steel, topical injuries and inflammations (a rare cause), unsoundness of the diges- tive organs, which impairs the nourish- ment of the body and vitiates the blood ; drinking too freely of cold liquors when heated (two cases illustrative of which are recorded by Dr. Blackall, which re- covered under the use of bleeding and antiphlogistic remedies). The last causes to which I shall advert are those of most frequent occurrence; they were those, I may mention, that prevailed in the case to which I wish more particularly to call the attention of the Society;—I mean the exposure to cold and wet, and the free use of spirituous « Vide Dr. Blnckall's work on the Nature aud Cure of Dropsies. t Vide a paper by Dr. Wells, in the third volume of the Medical and Chirurgical Transac- tions. , , $ VideGulstonian Lectures, 1S33, delivered by Dr. Bright ; published iu Med. Gaiette, June 22, 1833. i: