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.

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    microscopically it is proved that the starting-points of sup- purating foci are collections of micro-organisms inside the tubuli uriniferi. These tubules are lined with more or less necrosed epithelium. The suppurating centres are started, as we have already said, by schizomycetes which have penetrated the collect- ing tubules from the renal pelvis, and there formed colonies. This is Vircliow's canalicular parasitic nephritis (we have already spoken of the embolic vascular form), the pyelonephritis parasitica of lUehs ; the close connection of this form with the artificial introduction of pyogenic virus on infected instruments,, especially catheters, has been already recognised by Trcmhe. When the different suppurating centres enlarge and coalesce,, diffuse suppurative nephritis results—a type we have already described. In extreme cases the kidney is like a sponge saturated with pus, or a large sac of pus. This may again undergo further characteristic changes by the incrustation of its walls with urinary salts, continuous decomposition of its contents, formation of fatty detritus containing much cholestearin and by manifold pro- cesses of shrinking, and by the formation of tracts of new tissue. Frequently we find large renal abscesses separated from the pyonephrosis proper by septa of parenchyma, these septa being often permeated by purulent tracts. When the disease is unilateral, it sometimes ends favourably ; we then find the pelvis and calices contracted to a thick callous capsule, the ureter obliterated, and a so complete destruction of the kidney, that we only find a small remnant of the organ em- bedded in fibrous tissue. In such cases we find compensatory hypertrophy of the healthy kidney, similar to that found in exten- sive atrophy of one kidney from various causes, or in cases where one kidney is absent cougenitally or from nephrectomy. For anatomical details of this interesting compensation for the absence of the function of one kidney, we must refer the reader to the text-books of pathological anatomy, and content om-selves with the remark that it is now definitely proved, partly by ex- periments (extirpation of one kidney in growing animals), that a true hypertrophy does really occur, the glomeruli, the epithelium of the canaliculi, especially of those in the cortex, become enlarged, whilst it is not yet sufficiently agreed as to whether there is any increase in the number of the glomeruli or not {Bosenstein, Perl, Grraivitz, Israel, Bibbert, Leiclitenstern, Boström, Eckard, Tufficr, Lorenz and others). Besides these favourable consequences, we have comphcatious following perforations in various directions ; these are due to deep ulcerations of the mucous membrane with gangrenous inflamina- tion of the surrounding connective tissue ; then follow gravitation abscesses and all those other conditions described in a previous chapter (see also Paranephritis). In a certain number of cases, chronic pyelitis, in the form of