Text-book of diseases of the kidneys and genito-urinary organs / by Paul Fürbringer ; translated from the German with annotations by W.H. Gilbert ; commendatory letter from Sir Thomas Grainger Stewart.

  • Fürbringer, Paul W., 1849-1930.
Date:
1895-1898
Catalogue details

Licence: Public Domain Mark

Credit: Text-book of diseases of the kidneys and genito-urinary organs / by Paul Fürbringer ; translated from the German with annotations by W.H. Gilbert ; commendatory letter from Sir Thomas Grainger Stewart. Source: Wellcome Collection.

    15/356 (page 5)
    We shall treat on the changes brought about in the projecting parts of the pyramids under compression in the chapter on Hydronephrosis. We have thrice seen, together with the flattening, a pecuUar ring-like necrotic destruction of the papillae. This was accona- panied by constriction, and even setting free of the papillae. For rupture into neighbouring parts, and the possible simul- taneous discovery of concretions, see the chapter on Nephro- lithiasis. Ureter.—It is not rare to find similar changes in the bladder, whilst the ureter between them appears intact. On the other hand, all the signs of acute or chronic inflammation may be found in the ureter, such as dilatation, necrosis of the mucous membrane, etc. Halle has lately shown, by means of very careful investigations, that in by far the greater majority of cases the process may be described as a uretero-pyelitis ascendens. This is distinguished by numerous dilatations of the ureter, often in the form of a rosary; between the dilatations are valvular strictures, or indurated and cicatricial narrowing of the lumen. Finally, the frequent formation of cysts accompanying chronic inflammation has been either regarded as due to the retention of catarrhal secretion (Litten) or else due to softening processes, such as fatty degeneration, in the tissues of the mucous mem- brane, which are infiltrated with round cells (Ebstein). Kidney.—In moderate recent pyelitis, the change in the kidney itself is not very characteristic. This is mostly limited to hyper- aemia of the whole organ, especially of the papillae. Its section appears dull and succulent from the tissues being infiltrated by fluid, containing epithelium, pus corpuscles, bacteria, and also hyaline casts. Fully-developed pyelonephritis is quite different from the simple catarrhal form. This is usually met with in severe protracted cases of pyelitis. In such cases we find long tracts of necrotic inflamed tissue, running in the course of the straight tubuli uriniferi; the inflamed areas decrease in extent towards the summits of the pyramids, and are surrounded by a hyperaämic zone. Yellow streaks often extend as far as the surface of the kidney, which then appears spotted with yellow, whilst the surface of the section appears streaked with the same colour. The cortex may, however, be alone affected, the pyramids remain- ing free. Bazy has recently proved this in a series of cases. In explanation of the fact that the surface of the kidney is more commonly affected, Steven has lately suggested the prob- ability of bacteria being transported along the lymphatic tracts, while Liuliüig and others have shown connection of the lymphatic vessels of the ureter with those between the capsule and the parenchyma of the kidney. In contradistinction to the origin of metastatic renal abscesses,