Volume 1

The principles and practice of medicine / by Rustomjee Naserwanjee Khory.

  • Khory, Rustomjee Naserwanjee.
Date:
1885
Catalogue details

Licence: Public Domain Mark

Credit: The principles and practice of medicine / by Rustomjee Naserwanjee Khory. Source: Wellcome Collection.

    516/588 (page 500)
    cases, besides albuminuria and dropsy, other secondary changes are found. These affect the heart, blood-vessels, and other organs, and end in death by dropsy, uraemia, or complications. Causes.—These are predisposing and exciting. The predisposi- tion is common in children. The commonest exciting cause is the poison of scarlatina; nephritis is nearly as common in confluent smallpox, but rarely occurs in connection with measles and other exanthemata. All causes which induce albuminuria temporarily will, if neglected, give rise to inflammatory Bright's disease. Other blood poisons which similarly predispose to tubular nephritis are diphtheria, erysipelas, pyaemia, typhus fever, acute rheumatism, and pneumonia. Cold is the commonest cause in the adult. It acta with a special force on those exposed to draughts of cold air while perspiring. Heart disease, pregnancy, gout, and malaria are also causes of Bright's disease. Intemperance and large doses of can- tharides or turpentine have been known to bring on this disease. I^atliological changes.—Acute Bright's disease is a catarrhal inflammation of the uriniferous tubules, and has a tendency to pass through various stages. In the first stage, or that of active in- flammation, the kidneys become enlarged, softened, and mottled. The capsule is thin, opaque, and easily separable. The surface is smooth, the cortex dark red and swollen. On section a large quantity of blood oozes out; the cortical substance is increased in bulk, and is dotted with dark red points of extravasation throughout its substance. These dark points are the engorged Malpighian corpuscles. The vessels of the cortex, as well as those of the cones, are congested. The pyramids are hyperaemic and marked with red streaks. Opaque and bloody liquid is found in the calyces and pelvis. The whole structure appears somewhat coarser than natural. The convoluted tubes are swollen and opaque, and some- times contain blood. The microscope reveals distension of the capillaries; the tubules are found to be dilated, dark, opaque, and often occluded and compressing the capillaries. The tubes contain many detached epithelial cells, which are granular, opaque, and in a state of disintegration. In some cases all the tubes are aflected, in others comparatively few. The intertubular stroma is unafiected. The enlargement of the organ is due to distension of the capillaries, to exudation of fibrin, to increase of red corpuscles, and to increase of detached epithelial cells. In advanced cases the exudation increases, and the kidney becomes pale and more opaque. In this stage, unless death or recovery take place, the disease passes on to the second stage, known as fatty transformation. The kidney remains enlarged, the capsule is easily separable, the surface is mottled, and presents stellate veins. There is no extravasation of