The histology of granular kidney [with plates V and VI] / by Robert Saundby.

Date:
1880
Catalogue details

Licence: Public Domain Mark

Credit: The histology of granular kidney [with plates V and VI] / by Robert Saundby. 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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    ,/> Reprinted fromthe^ Transactions of the Pathological Societg of Zo7idon’ forlSSO.^ The histology of granular kidney. By Eobeet Saundby, M.D. [With Plates V and VI.] EEIGHT recognised three well-marked pathological types of dis- eased kidney, associated with albuminuria, but was ignorant of the intimate nature of the morbid process. In accordance with current pathological doctrines he regarded each variety as a stage in the development of a deposit or growth giving rise to granula- tions, and hence he called the whole process “ granular degenera- tion.” At present we restrict the term “granular kidney” to what Bright regarded as the third stage, and it is believed by many to have pathological and clinical characters which distinguish it altogether from the other two. This separation was not effected early in the history of Bright’s disease, nor was it completed with- out opposition; indeed, it cannot be said that at the present time the points of distinction are generally agreed upon. The naked- eye appearances are sufficiently characteristic. It is only when we attempt to determine the intimate nature of the changes which have occurred that differences of opinion arise. Bright’s doctrine of a morbid deposit soon gave way to the theory of an inflammatory process, first taught by Eayer, and confirmed by the histological researches of Johnson, Prerichs, and Eeinhardt. According to Prerichs, the three varieties or types described by Bright corre- sponded to three stages of an inflammatory process, characterised respectively by;—I, hypersemia with exudation; 2, fatty degeneration of the exudation; 3, absorption of the degenerated exudation and atrophy of the organ. Nothing could seem more apt than this description, but it soon had to yield its place to the doctrine of pa- renchymatous inflammation brought forward by Virchow, according to which the seat of the lesion was the epithelium of the kidney. Dr. Johnson adopted this view with slight modifications, as he believed that the, so-called, second and third stages often occurred independently of the first, or at least that they were not preceded by an acute inflammatory attack. He drew attention to several points in the histology of these changes, especially to the small cells occupying the tubules and the hypertrophy of the walls of the blood-vessels as characteristic of the small red kidney, which he