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
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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.

    7/18 (page 7)
    Case IV.—J. M., brushmaker, aged 33. His case was recorded in the previous paper. Of a syphilitic constitution, he exhibited distinct traces of the cacliexia. While under observation, he passed from GO to 80 ounces of urine daily, of low specific gravity, albuminous, with hyaline tubecasts,and contaming here and there a fatty cell. He was dismissed from the Infirmary about the middle of August 1860, and for a year afterwards I saw him occasionally. He always retained tlie cachectic appearance, and conthmed to make large quantities of urine. Until the end of October 1861 he Avas going about attending to his work, but sud- denly his urine diminished in quantity, and became bloody, and on the follow- ing day he was seized with convulsions. These continued for some days. He was removed to the Infirmary, wliere be died on 5th November. In the intervals of his fits he was conscious, though unable to speak. On post-mortem examination there Avere found syphilitic necrosis of the cranial bones, and other evidences of constitutional syphilis. The liver was large and distinctly waxy; the spleen presented the degeneration in a slight degree; the kidneys were somewhat contracted, firm, and presented an exqui- site specimen of the amyloid degeneration of the vessels and Malpighian bodies. In these four cases we have a continuation of the history of this disease in cases previously published. The following cases are new. Case V.—J. M., labourer, aged 18, admitted to the Royal Infirmary,, under the care of Dr Bennett, 13th September 1861. He stated that six weeks pre- vious to admission he caught cold, had cough, with frothy expectoration, and soon afterwards that he noticed that he was passing more water than usual. Had frequently to get up during the night to empty his bladder. About a month later his feet began to swell. ' . . < On admission, the heart-sounds were normal. There were the ordinary signs, and symptoms of bronchitis. There was no dropsy. The skin was cool and moist. There was lumbar pain. The urine was pale, very copious; of specific gravity 1012; highly albuminous; contained granular and fatty tubecasts. He had great thirst. The bowels were constipated. The amount of urine varied between 3d and 15th October from 75 to 122 ounces. Only on three days was it below 100 ounces. Throughout that month the quantity continued large, though on some days it was considerably diminished, and it was almost invariably in excess of the fluids drunk. The pulmonary symptoms rapidly increased in severity. The upper half of one lung became distinctly dull, while the bronchial afi'ection increased. There was some degree of dropsy. The blood contained fully double the natural proportions of white corpuscles. During November and December the daily quantity of urine gradually diminished. The albumen did not diminish. The casts became less fatty. General dropsy set in. This symptom became so distressing, that, on 10tli.June, acupuncture was employed for the relief of the dropsy. At the same time the pulmonary symptoms steadily increased, and the patient died on 13th January. On post-mortem examination, there was general dropsy of cellular tissue and serous cavities. The heart was somewhat hypertrophied. Both pleurie were adherent. The lungs were cedcmatous, and contained distinct traces of tubercle. The kidney capsule was adherent; the surface granular. The cortical substance somewhat atrophied. Many of the tubules were filled with finely granular fatty matter. The spleen was firm ; the intestines were cedematou.s. On adding a solution of iodine, many of the arteries and Mal- pighian bodies assumed a reddish orange colour, and on the further addition of dilute sulphuric acid became reddish purple. There was slight waxy degenera- tion of the liver, spleen, and of portions of the intestines. Ca8e VI.—I. C, .Tt. 16, a .servant, admitted to Ward XI., 27th February 1861, under the care of Dr I.,aycock. She had in the year 1860 been aflectud with phthisis puhnonalis, and had somewhat improvecl. After I had lost sight of her she observed that she had occasion to get up several times every night to make water, and that each time she made a large quantity. About January she was exposed to cold and wet, and noticed liiat her feet and ankles swrlietl,