Relation of the diseases of the kidney, especially the Bright's diseases, to diseases of the heart : the Middleton Goldsmith lecture, delivered before the New York Pathological Society, April 18, 1888 / by J.M. Da Costa.

  • Da Costa, Jacob Mendez, 1833-1900.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Relation of the diseases of the kidney, especially the Bright's diseases, to diseases of the heart : the Middleton Goldsmith lecture, delivered before the New York Pathological Society, April 18, 1888 / by J.M. Da Costa. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    organ. The epithelium of the tubes is swollen, and finally undergoes granular degeneration. I have, by the analysis of the cases, endeavored to give you a proof how rarely valvular disease of the heart leads to chronic disease of the kidneys, other than coneestion. When it does, the form of affection is that of a chronic congestion, which, in its turn, passes into a parenchymatous nephritis. The granular contracted kidney does not, I believe, result from the process of congestion just alluded to; though, as I have already said, occasionally, especially in elderly people, the kidneys from long-standing congestion may appear hard and exhibit a slight amount of fibroid change. These statements seem at variance with those of one of the most eminent of your members, Dr. Delafield,' who, in 137 cases of death from heart disease, reports 27 large white kidneys, 29 atrophied kidneys, and 28 of chronic nephritis which could not be classed as either large white or atrophied organs. Perhaps the apparent discrepancy is to be explained by the cases being heart disease of which it was not specifically known whether it preceded the renal affection or followed it. During life it may be very difficult in individual cases to determine whether we have, as the result of the heart malady, simply a congestive condition of the kidneys or real Bright's disease ; in truth, as in both states dropsy is a prominent symptom, we obtain but litde aid from the general symptoms, having to base our opinion largely on an accurate cardiac investi- gation. It may be thought that the urine would afford us much assistance ; but this it does not always do. 1 System of Medicine by American Amliors, vol. iv.