John R. Bradford & Edmund Owen

“ Extreme congestion of the kidneys may be produced by exposure to cold, owing to some intimate relationship existing between the cutaneous and the renal vessels, the constriction of the one being accompanied by the dilatation of the other. Infective diseases, such as typhoid fever, pneumonia, scarlet fever, in fact, most acute specific diseases, produce during their height a temporary nephritis, not usually followed by permanent alteration in the kidney; but some acute diseases cause a nephritis which may lay the foundation of permanent renal disease. ”

“ If it is not discoverable on gently pinching the kidney between the finger and thumb, the kidney had better be opened in its convex border and explored by the finger. Often it has happened that when a man has presented most of the symptoms of renal calculus and has been operated on with a negative result as regards finding a stone, all the symptoms have nevertheless disappeared as the direct result of the blank operation. ”

“ The lesions of the kidney are probably produced by irritation of the kidney-structures owing to the excretion of toxic substances either ingested or formed in the body; it is thought by some that the malady may arise as a result of exposure to cold. The principal causes of Bright’s disease are alcoholism, gout, pregnancy and the action of such poisons as lead; it may also occur as a sequel to acute diseases, such as scarlet fever. Persons following certain occupations are peculiarly liable to Bright’s disease, e.g. engineers who work in hot shops and pass out into the cold air scantily clothed ”

“ Rupture of the kidney may result from a kick or other direct injury. Vomiting and collapse are likely to ensue, and most likely blood will appear in the urine, or a tumour composed of blood and urine may form in the renal region. An incision made into the swelling from the loin may enable the surgeon to see the torn kidney. An attempt should be made to save the kidney by suturing and draining; unless the damage is obviously past repair, the kidney should not be removed without giving nature a chance. ”

“ Uraemia is of toxic origin, and it is probable that the dropsy of renal disease is due to effects produced in the capillaries by the presence of abnormal substances in the blood. High arterial tension, cardiac hypertrophy and arterial degeneration may also be of toxic origin, or they may be produced by an attempt of the body to maintain an active circulation through the greatly diminished amount of kidney tissue available. ”

“ In most diseases the quantity of urinary water is diminished, especially in those in which the activity of the circulation is impaired. There are diseases, however, more especially the granular kidney and certain forms of chronic Bright’s disease, in which the quantity of urinary water is considerably increased, notwithstanding the profound anatomical changes that have occurred in the kidney. There are two forms of suppression of the urine: one is obstructive suppression, seen where the ureter is blocked by stone or other morbid process ”

“ In congenital cystic disease the organ is transformed into a mass of cysts, and the enlargement of the kidneys may be so great as to produce difficulties in birth. The cystic degeneration is caused by obstruction of the uriniferous tubules or by anomalies in development, with persistence of portions of the Wolffian body. In some cases cystic degeneration is accompanied by anomalies in the ureters and in the arterial supply. Growths of the kidney are sometimes found in infants ”

“ Serious complications may result from the presence of a stone in the kidney, such as hydronephrosis, from the urinary secretion being pent up behind the obstruction, or complete suppression, which is apparently produced reflexly through the nervous system. ”

“ The symptoms of renal calculus may be very slight, or they may be entirely absent if the stone is moulding itself into the interior of the kidney; but if the stone is movable, heavy and rough, it may cause great distress, especially during exercise. ”

“ Once a minute calculus has been formed, its subsequent growth is highly probable, owing to the deposition on it of the urinary constituent forming it. Calculi formed in the pelvis of the kidney may be single and may reach a very large size, forming, indeed, an actual cast of the interior of the expanded kidney. ”

“ When the overgrowth of fibrous tissue is considerable, the surface of the organ becomes uneven, and it is for this reason that the term granular kidney has been applied to the condition. In acute Bright’s disease the kidney is increased in size and engorged with blood, the changes described above being in active progress. ”

“ Effects on the Body at large.—These may be divided into the persistent and the intermittent or transitory. The most important persistent effects produced by disease of the kidney are, first, nutritional changes leading to general ill health, wasting and cachexia ”

“ Many of these effects are dependent upon the action of poisons retained in the body owing to the deficient action of the kidneys. It is also probable that abnormal substances having a toxic action are produced as a result of a perverted metabolism. ”