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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    and her urine became diminished in quantity. She had also some lumbar pain and diarrhoea, and on this account entered the Infirmary. On her admission I had an opportunity of examining her, and found the signs of phthisis considerably developed. She looked ansemic. Her appetite was bad. She frequently vomited. _ Pier bowels were very loose. The amount of her urine could not be determined on account of the diarrhoea. It was highly albuminous; specitic gravity 1030. Contained hyaline casts. The liver and spleen were enlarged. The blood contained an unusual number of white corpuscles. There was considerable general dropsy, and she died a few days after admission. Atitopsy.—The lungs were found to contain large quantities of tubercle, and on the intestines there were numerous irregular tubercular ulcers. The liver, kidneys, and spleen were found to be large and waxy. The Malpighian bodies and small arteries of the kidneys assumed a reddish purple colour on the addition of iodine and sulphuric acid. Many of the hepatic cells and the Malpighian bodies of the spleen presented the same reaction. Case VII.—J. C, ust. 21, a miner, was admitted, under the care of Dr Haldane, into the Royal Infirmary, in January 18C4. He was of stunted growth. He had worked underground since he was seven years of age. At the age of sixteen he had pneumonia, and ever afterwards was breathless and liable to colds. He used to notice that he had to rise during the niglit to make water, and was often interrupted at his work from the same cause. Two months before admission he was exposed to cold and wet, and became drop- sical. His urine diminished in quantity; its specific gravity was 1015, albu- minous, and contained some casts. He died exhausted, partly by the renal and partly by pulmonary affection. Autopsy, forty-two liours after death. The body was greatly emaciated. The lungs contained tubercle and carbonaceous matter. There were some vomicse towards the apices. The heart was dilated. The liver normal. The spleen presented amyloid degeneration of the Malpighian bodies. The kidneys were of good size; many of the tubercles filled with fatty granules and exuda- tion. The small arteries and Malpighian bodies presented a translucent appearance, and assumed a blue colour on the addition of iodine and sulphuric acid. The villi of the small intestine also presented this degeneration. Case VIII.—J.N., tet. 32, Ward VII., under the care of Dr Haldane, in the Royal Infirmary. Examined 25th January 1864. Fourteen years ago, when the patient was eighteen years of age, he had chancre, and other signs of constitutional syphilis. These syphilitic symptoms con- tinued to recur at intervals for a long time. Six years ago, having been exposed to cold and wet, he had what seems from his description to have been an attack of acute renal dropsy. From this he recovered. Has since had pains in the tibia, worst at night; in the epigastrium, and in the region of the kidneys. Towards the end of last year he observed that he was obliged to get up several times every night and make water, and that on each occasion he made a con- siderable quantity. He estimated the amount to be about 160 ounces. This has continued to the present time. On admission, his liver was found enlarged. In the line of the nipple it measured 7 inches vertically; in the middle line 5f. The spleen was also enlarged; measured 4i inches vertically, and 6 inches across. The blood con- tained an excess of white corpuscles, {'md the red did not form rouleaux, but ii-regular clumps; they had a tendency to tail. The tongue was loaded in the centre, furred at the edges. The appetite was good, but some sickness and vomiting followed every meal. The bowels were natural. The heart sounds were normal. Pulse about 92 per minute. There was some crepi- tation heard at the bases of both lungs, and at the apex of the right. There was pain on pressure over the kidneys. The urine varied in amount, from 90 to 130 or 150 oz. ; was pale, of low specific gravity, contained much albumen, but no tubecasts could be found. There was also enlargement of the right testicle, and dropsy of the left tunica vaginalis. There were numerous