Two cases of symmetrical necrosis of the cortex of the kidneys associated with puerperal, eclampsia and suppression of urine / by R. Jardine and J.H. Teacher.

  • Jardine, Robert.
Date:
[1911?]
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Licence: In copyright

Credit: Two cases of symmetrical necrosis of the cortex of the kidneys associated with puerperal, eclampsia and suppression of urine / by R. Jardine and J.H. Teacher. 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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    sometimes over 100, but at other times slow and very feeble,— barely perceptible at the wrist. It seems not improbable that the condition of spasm of the vessels existed in the internal organs, and particularly in the kidneys, which are usually regarded as apt to be affected by conditions affecting the skin. Spasm of the smaller branches of the renal arteries is therefore suggested as the determining cause of the thrombosis. The condition, if this explanation be accepted, would come into the category of symmetrical necroses similar to those which are seen at the extremities of the ears, nose, and limbs in certain cases of Eaynaud's disease. Case 1. Clinical History.—-Mrs. McC, 7-para, set. 36, seven months pregnant, was admitted to the Glasgow Maternity Hospital on 11th March 1906, suffering from fits. These had commenced in the morning, and there had been seven or eight of them. A few days before, swelling of the legs and feet had been observed, and the day before admission the patient had complained of severe headache. On admission the patient was unconscious, and very restless, with con- siderable oedema of the face, legs, and lumbar region. The uterus was soft and flaccid, and the os admitted a finger. The heart sounds were pure, and the pulse 110, of moderate tension. The urine became almost solid on being boiled. Twelve fluid ounces of blood were drawn from the arm, and 2 pints of saline were transfused. The stomach was washed out, and a hot pack, a purgative and a dose of chloral and bromide were given. There were three more fits before midnight. March 12.—The patient was semi-conscious, but did not reply to questions. It was afterwards discovered that she was stone-deaf. The urine contained 10 per 1000 albumin (Esbach) and over 1J per cent, of urea. There were granular tube casts but no blood in it. She passed 35 fluid oz. in twelve hours, i.e. from 9 p.m. on the 12th to 9 a.m. on the 13th. March 13.—About 3.30 p.m. she delivered herself of a seven months' dead foetus. A little urine was passed. There had been almost complete anuria from midday of the 13th. The urine obtained in the early morning showed only 2 per 1000 albumin (Esbach) and If per cent, of urea. March 14.—At 3 p.m. the patient had a fit. The temperature was 98° F., and the pulse from 100 to 120. No urine was excreted. Saline infusion of 2 pints given. March 15.—The patient was sick and vomited dark material. The mental condition was brighter, and she did not seem to suffer any inconvenience from the anuria. The temperature was 99° and the pulse 90. Patient took a good deal of fluid throughout. March 16.—-The skin showed a tinge of jaundice. The patient was quite bright mentally, and complained of hungei\ At noon \ gr. of pilocarpine was given hypodermically, followed by a hot pack. This treatment, along with cupping or poulticing over the kidney, was repeated on subsequent days. About half a fluid ounce of urine was obtained by catheter. There was only a trace of albumin in it. March 17.—The jaundice was a little deeper. One fluid drachm of urine was obtained by catheter. The pulse was still good, 80 to 90. March 18.—Dr. Newman cut down on to the right kidney. The capsule was incised and stripped off one side of the kidney nearly to the hilum, and off