Further observations on the waxy or amyloid form of Bright's disease / by T. Grainger Stewart, M.D.

  • Stewart, Thomas Grainger, 1837-1900.
Date:
1864
Catalogue details

Licence: Public Domain Mark

Credit: Further observations on the waxy or amyloid form of Bright's disease / by T. Grainger Stewart, M.D. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    clavicle; appetite irregular; urine about 105 oz. daily, of a pale yellow colour, specific gravity ranging iVom 1005 to 1012, of acid reaction, contained much albumen, much epithelium, and no sugar; no tubecasts were found. In this condition she continued when last seen. Case XVI.—Mr , a gentleman of independent fortune, bad, at about the age of 14, an abscess in the right side, near the hepatic region, but the source of which was not ascertained. He after this was healthy, vigorous, a keen sportsman; but at the age of 31 he began to complain of griping pains aud severe diarrhoea. On examination it was found he was passing large quan- tities of urine. He was frequently obliged to get up during tlie night, in order to micturate. Tlie urine was quite clear, very pale, of specific gravity 1008, contauiing albumen in considerable quantity. Tlie casts were few, hya- line, with occasional fatty cells. The iippetite was capricious; the stools were pale, and of an offensive odour. The liver was not enlarged. His symptoms gradually increased, and he died about the age of 32. No autopsy was permitted; but his symptoms were so distinct as to incline me decidedly to reckon this a case of waxy degeneration of the kidney and intestine. The following case illustrates the apparent curability of this degeneration. The patient exhibited all the symptoms of the degeneration of the organ, but these symptoms gradually disap- peared :— Case XVII. Mr M., a gentleman, ffit. 21, resident in Edinburgh, has been under my care for some months. Some years ago he fell into a state of delicate health. His appetite became poor, and lie became subject to occasional hicmorrhages, from the nose and other sources. His liver was greatly enlarged, extending downwards to the umbilicus; the quantity of urine mcreased to a marked extent, and was albuminous ; his bowels were very irregular; and his general health much im- paired. Under a course of iron, and of iodide of potassium, liis general health improved, the liver diminished in size, and the urine became free of albumen. For about a year past no albumen has been observed; and his strength has become such as to enable him to resume his ordinary employment, and to work at it regularly during the past winter. The liver continues, even now, somewhat enlarged, and the cachectic appearance continues, but the urinary symptoms have very markedly improved. The following case is of interest, as one possibly of amyloid degeneration of tlie kidneys, though the disease is not in the mean- time distinctly defined:— Case XVIII.—W. L., a brassfoundei-, set. 53, was admitted to the Royal Infirmary in March 1864, under the care of Dr Haldane. He states that he never had any venereal disease, excepting an attack of gonorrhoea, thirty years ago. He has been tolerably steady, but, while working in London, was accustomed to consume a good deal of beer. He noticed for some months past that he has been obliged to rise during the night to make water; and that if he was much confined his feet swelled slightly. In the end of February he vomited some clotted blood, and his stools were black. On admission, he was anaemic; the skin and sclerotic slightly icteric; the eyelids were distinctly cedematous; the tongue was furred ; the appetite poor ; the bowels constipated. The liver was of normal size; the spleen measured 3 inches vertically, and 4J inches across. The red corpuscles of the blood were pale and flabby, and the white were not increased in number. The heart and lungs were normal. The urine was, on the day following his admission, 50 oz., of specific gravity 1015; of a straw colour; acid reaction; contained a sliglit mucous cloud ; otherwise normal. The following day, how-