Renal diseases : a clinical guide to their diagnosis and treatment / by W.R. Basham.

Date:
1870
Catalogue details

Licence: Public Domain Mark

Credit: Renal diseases : a clinical guide to their diagnosis and treatment / by W.R. Basham. 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.

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    fever. It appears to me that some antecedent bodily condi- tion must exercise a large influence in predisposing the renal organs thus specially to sufl'er in a certain number of cases of scarlet fever. Observation convinces me that hi those famihes in which there is an obvious strumous taipt these renal dis- orders after scarlet fever are more frequent than among those free from this sign of deteriorated vital energy. I do not presume to say that this can be proved, but I am firmly of opinion, justified by long observation, that the antecedent fever is the lesser factor in this proposition. I have elsewhere expressed a similar opinion. The renal disorder after scarlet fever commences as a true inflammatory engorgement. Death taking place in the first week, the kidneys are found of various degrees of inflam- matory redness, purplish-red, brownish-red, chocolate-red; the cortex covered with arborescent vessels tinged with blood; the Malpighian bodies swollen, many ruptured, and blood escaping into the uriniferous tubes, mixed with the scanty and all but suppressed urine. The microscope exhibits these tubes filled with blood, and it is very easy by pressure to squeeze from the apex of the cones a fluid which is blood mixed with fibrinous casts of these tubes, accompanied by granular matter and renal epithelium. When the patient survives this period, and the congested state of the kidneys subsides, this renal epithelium is cast off, for the inflammatory stasis has so injured the vitality and secreting power of many of these ceUs that they have become effete and useless. This destruc- tion of the renal cells has been called a process of desquama- tion, and it has been supposed that the uneliminated part of the scarlatinal poison falling on the kidneys has been followed by a shedding of these cells, just as the cuticle is shed or peels off, and by analogy the disease has been designated desquamative nephritis. The name signifies little, provided the pathological process be understood. But it must be clearly understood that this casting off of the renal cells in the form of granular epithelial casts is not a process similar to what takes place in the skin.