On a case of acute atrophy of the kidneys and liver in a pregnant woman / by T. Grainger Stewart.

Date:
[1866?]
Catalogue details

Licence: Public Domain Mark

Credit: On a case of acute atrophy of the kidneys and liver in a pregnant woman / by T. Grainger Stewart. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    5/8 (page 5)
    which it occurred, point strongly to some cause operating within the blood. The case, then, supplies an additional point in the history of acute yellow atrophy, and decidedly supports the view of its being dependent on a blood-poison. The only similar cases that I have found are three, which were published by Rokitansky in 1859, under the name of fatal steatosis of the liver and kidneys.^ I shall not detail his cases, but merely mention certain general facts in regard to them. All were females, unmarried, aged 23, 38, and 8 years respectively. Two had been in depressed spirits. All were stout, well-nourished, and died after about a week's illness, during which the leading symptoms were—fever, headache, vomiting of dark matters, convulsions, and coma; in two there was slight icterus. On post-mortem examina- tion, ecchymoses were found in many of the internal organs. The livers were large, pale, flabby, and fatty ; the kidneys were also lai'ge, fatty, congested, and mottled with extravasation of blood; the urinary bladders contained almost no urine; in two, the stomach and intestines contained altered blood. Microscopic examination showed in all three cases extreme fatty degeneration of the liver and kidneys. Eokitansky distinctly recognises a poisoned condition of the blood, which, however, he regards as a consequence, not a cause, of the hepatic and renal affections; and, in accordance with a favourite view, he regards the renal affection as secondary to the hepatic. He refers the fatty condition of the liver to that state of the system in which an excess of fat is present and a tendency to fatty deposition exists, and having excluded, with regard to the kidneys, the theory that it might depend upon Bright's disease, he concludes by saying, There can be little doubt that the steatosis of the kidney was secondary to the primary steatosis of the liver; just as little can we doubt—from the diminution of urine consequent upon kidney disease on the one hand, and the slight degree of cholgemiaon the other hand—that the sudden development of the fatal symptoms depended upon uraemia. It Avould accordingly appear that fatty degeneration of the liver may occur in an indi- vidual inclined to excessive fatty deposit, and to this, sooner or later, a fatty condition of the kidney may be superadded, both of which, gradually and unobserved, may attain such a degree that secretion of bile and urine is suspended, and death supervenes sud- denly, after the appearance of slight icterus, by urajmia, and an htemorrhagic decomposition of the blood. Notwithstanding the profound respect to which every opinion of Rokitansky is entitled, I would venture to suggest that the cases are capable of another interpretation, especially when examined by the light of the remarkable case which I have just described. It is ' Ueber lethale Leber- und Nieren Steatose, von Prof. Rokitansky. Zeita- chrift der k. k. Gesellschaft der Aerzte zu Wien, Aug. 1859.