A treatise on Bright's disease and diabetes with especial reference to pathology and therapeutics / by James Tyson ; including a section on retinitis in Bright's disease by William F. Norris.

Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on Bright's disease and diabetes with especial reference to pathology and therapeutics / by James Tyson ; including a section on retinitis in Bright's disease by William F. Norris. 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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    simultaneously effused blood; for blood-casts and epithelial casts constantly accompany each other. When the epithelial cells and their fragments—often their nuclei only—are few, they are separated by intervals, at times quite regular, of a hyaline material, to which they may be attached, or in which they may be imbedded. And it is the nature of this hyaline material which is the subject of dispute. It seems most reason- able to consider it an exudation from the blood of a fibrinous or an albuminoid substance, which coagulates after entrance into the tubules, entangling there, as does fibrin, whatever substances may be in the tubule, and occluding it for the time being. That it is true fibrin coagulated is not incon- sistent with the modern doctrine of fibrin formation. For this, fibrinogen and fibrinoplastin are essential. The former is furnished by the blood-plasma, the latter by the blood-cor- puscles, and as the latter are constantly present, although it may be not always in large numbers, the conditions of coagu- lation are furnished. Where there is haemorrhage into the tubules, both conditions of coagulation are abundantly present and blood-casts are also formed. It is true, the chemical prop- erties of casts have been investigated, by Axel Key, and also by Rovida, who assert them to be altogether different from those of fibrin. But, that the hyaline material is in many in- stances some sort of exudate rather than a result of a metamor- phosis of cells, is sustained by the fact that the hyaline is the only shape of cast formed in the slightest derangements of the kidney, as when there is a mere transitory congestion of the organ, and where there is no alteration of the epithelium whatever. The same objection holds to their being a secretion of the cells lining the tubules. Third, the two forms of granular cast have probably differ- ent modes of origin. In the case of the dark granular cad the cells have undergone complete disintegration, and the prod- ucts of this form a closely packed, dark, granular mass. If many red blood-disks happen to be in the tubule and share the breaking up, a yellowish tinge is communicated to this form of cast. In other instances the granular matter is less abun-