On the connection of Bright's disease with changes in the vascular system : with illustrations from the sphygmograph / by A.L. Galabin.

  • Galabin, Alfred Lewis, 1843-1913.
Date:
1873
Catalogue details

Licence: Public Domain Mark

Credit: On the connection of Bright's disease with changes in the vascular system : with illustrations from the sphygmograph / by A.L. Galabin. Source: Wellcome Collection.

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    some light upon the difference of their pathology. The first requisite in a satisfactory explanation of renal dropsy is that it should account for that difference in its distribution from that of cardiac dropsy, whereby the one may generally he distinguished at a glance from the other. Now, the amount of transudation and absorption through the walls of the ves¬ sels must depend on the resultant of chemical or vital actions, and of the mechanical laws of osmosis, and any disturbance of either conditions may produce an altered result. There are only two mechanical conditions which would tend to increase exosmosis, namely, an increased pressure within, or a diminished specific gravity of the contained fluid. Now, pressure at a lower point of the body exceeds that at one which is higher, but in other respects exactly similarly situated, in proportion to the difference of vertical height. Hence any effect of excessive pressure would he seen most in dependent parts. This is exactly what occurs in cardiac dropsy, which is generally agreed to be the result of increased pressure, and does not occur in renal dropsy. The conclusion is clear tliat renal dropsy cannot result from increased pres¬ sure, and, therefore, if mechanical at all, it can only be the effect of diminished specific gravity. The effect of this would be equally diffused, and would, therefore, be most manifest, as in renal dropsy it is, where the tissues are loosest. It is an old opinion that renal dropsy is caused by poorness of blood, resulting from the drain of albumen. Poorness of blood is a somewhat vague expression; for the blood is, in one sense, poor in cases of granular kidney, where there is no dropsy, for there is then a scarcity of red corpuscles. But it is only the specific gravity of the liquor sanguinis which can mechanically affect the result, since the corpuscles would behave only as foreign bodies floating in the fluid. For direct evidence as to the state of the blood,—since bleeding is now never performed in Bright’s disease,—I have to refer back, as all writers do, to the observations published by L)r. Christison. It is true that he regarded a granular