Dialysis

“ This is something slightly different from mere solution. Many of the solids of the tissue waste are of a nature to irritate and even disorganise the kidney, if they be brought to that organ for excretion in too concentrated form. There is no reason to suppose that the kidneys are liable to suffer from over-work if the specific secreting power of the [604] kidney cells be not too heavily taxed. If only the products of disassimilation be diluted, so that they can be passed through the kidney by the simple process of exosmosis, the organ will discharge its function without injury or exhaustion. ”

“ Ten cubic centimetres of the dialysate are taken, by means of a closed pipette passed through the toluol layer, and poured into a dry, wide, and absolutely clean test-tube. For each dialysate, as a matter of course, a separate, absolutely clean and dry pipette is used. One's work should never be arranged in such a manner that the pipette has to be hurriedly cleansed with alcohol, water, or ether after use, for the cleaning in this case may very easily be insufficient. ”

“ Now the mere mechanical flow of such prodigious doses of fluid through the various outlets—the bowels, kidneys, skin, &c. must sweep away morbid secretions, and contribute to the breaking down of obstructions in different organs, independently of the medicinal agents that are diffused through the mass of liquids in the greatest possible state of division and solution—circumstances which enable them to permeate and penetrate through innumerable capillary tubes and complicated glandular apparatuses, where grosser materials could never reach. ”

“ For this reason, should the kidneys of a man be once attacked by disease, the malady is not easily expelled. For it is as though many kidneys were diseased and not merely one; which naturally enhances the difficulties of a cure.
The duct which runs to the kidney from the great vessel does not terminate in the central cavity, but is expended on the substance of the organ, so that there is no blood in the cavity, nor is any coagulum found there after death. A pair of stout ducts, void of blood, run, one from the cavity of each kidney, to the bladder ”

“ When the kidneys are not working the skin carries off much urea. In fact, a close relationship exists between the kidneys and the skin in the matter of excretion. Thus, with increased perspiration in warm weather comes decreased urine, while in cold weather the blood is sent in and the urine increased in amount.
To incite action of the kidneys drugs known as diuretics may be used. These act in two ways, by stimulating the kidney cells directly and by acting on the general circulation or nervous system. Any emotional or nervous excitement increases the flow of urine. ”

“ The mechanism of jaundice resulting from active congestion of the liver is readily explained on physiological grounds.
The congested condition of any gland is unfavourable to secretion. We all know, for example, that congestion of the kidney is accompanied by a suppression of the urinary secretion, and that the secretion is re-established as the congested condition of the organ diminishes. The suppression of the renal secretion is no doubt due to the engorged capillaries pressing upon the secreting structure, and ultimate ramifications of the urine tubes, and thereby annulling their functions. ”

“ The glands, moreover, are more or less interchangeable in their functions, that is, they have vicarious function, and one gland can take up and do for another what that other is for some reason unable to do. In jaundice, where there is stoppage of the bile duct, the kidneys help out the liver by excreting the bile. If one kidney is removed the other does work for both, and the glands of the skin may help out the kidneys or vice versa. Hemorrhage from the lungs sometimes occurs in suppression of the menses. ”

“ But more usually the organ is loose under the peritoneum, and not efficiently supported in its fatty bed. Movable kidney produces a variety of symptoms, such as pain in the loin and back, faintness, nausea and vomiting—and the function of the organ may be seriously interfered with, owing to the ureter becoming kinked. In this way hydronephrosis, or distension of the kidney with urine, may be produced. The return of blood through the renal vein may also be hindered, and temporary vascular engorgement of the kidney, with haematuria, may be produced. ”

“ The tubules become blocked by the epithelium, and distended with the pent-up urine; this is one cause of the increase in size that the kidneys undergo in certain forms of Bright’s disease. The lesions in the tubules and in the glomeruli are not generally uniform. The interstitial tissue is always affected, and exudation, proliferation and formation of fibrous tissue occur. In the granular and contracted kidney the lesion in the interstitial tissue reaches a high degree of development, little renal secreting tissue being left. ”

“ I would observe however that many of the secretions are much less active during the first years, than they are afterwards; such are those of the salivary glands, the liver, &c. The kidneys being destined to throw out the residue of digestion, as much and more often than that of nutrition, are in a state of activity in proportion to that of the first function. The infant often passes urine, as he frequently voids excrements. It is not because many substances, returning from the organs which they have nourished, present themselves to the kidneys, to be thrown out by this part. ”

“ II. The irritative diseases of the kidneys, pancreas, spleen, and other glands, are analogous to those of the liver above described, differing only in the consequences attending their inability to action. For instance, when the secretory vessels of the kidneys become disobedient to the stimulus of the passing current of blood, no urine is separated or produced by them; their excretory mouths become filled with concreted mucus, or calculus matter, and in eight or ten days stupor and death supervenes in consequence of the retention of the feculent part of the blood. ”

“ Water, being the necessary solvent of the solid matters in all the fluid secretions, is secreted in greater or less quantity by all the important glands. The kidneys are the chief emunctories of water,—i.e. they have to separate it from the blood [Pg 274] when it has entered in an unnatural amount. But in the excretion of water there exists a compensating relation between the skin, kidneys, and bowels,—particularly between the two former. So that when water is not properly excreted by the kidneys, it may pass out by the skin, and vice versâ. ”

“ In the same way the kidneys can also be kept in good condition if too much meat be not taken. These eliminate the end-products of meat food, and the more of such products that pass through the kidneys, the more of them are taken from the blood and excreted by means of the fine epithelia of the kidney tubules, and thus the more is the work done by these organs; and we have mentioned that any overwork of an organ may be followed by its exhaustion. ”

“ An enhancement of the pressure of the blood flowing through the kidney had no influence on the quantity of the secretion passing away. An increased rate of movement on the part of the blood, on the other hand, increased in equal degree the quantity of urine. On a solution of common salt or of mere serum sanguinis being poured through the kidney, no secretion followed. ”

“ It is exceptional for the large branches of the renal artery to be blocked, so that the symptoms produced in the ordinary cases are only the temporary appearance of blood or albumen in the urine. Blocking of the main renal vessels as a result of disease of the walls of the vessels may lead to disorganization of the kidneys. Blocking of the veins, leading to extreme congestion of the kidney, also occurs. ”

“ Hyaline casts are the least significant of all the casts, [p. 115] and occur in many slight and transitory conditions. Small numbers are common following ether anesthesia, in fevers, after excessive exercise, and in congestions and irritations of the kidney. They are always present, and are usually stained yellow when the urine contains much bile. While they are found in all organic diseases of the kidney, they [p. 116] are most important in chronic interstitial nephritis. Here they are seldom abundant, but their constant presence is the most reliable urinary sign of the disease. ”

“ Wastes given off by the Blood in the Kidney.—In the glomerulus the blood loses by osmosis, through the very thin walls of the capillaries, first, a considerable amount of water (amounting to nearly three pints daily) ; second, a nitrogenous waste material known as urea; third, salts and other waste organic substances, uric acid among them.
These waste products, together with the water containing them, are known as urine. The total amount of nitrogenous waste leaving the body each day is about twenty grams. It [Pg 342] is passed through the ureter to the urinary bladder ”

“ Adhesions of the intestines from old inflammatory troubles, floating kidney and bad circulation may each be a cause of painful digestion. Again, a dyspepsia that will not yield to treatment is often one of the symptoms of renal disease, or, in young people of fifteen to twenty years of age, it may be the earliest sign of a gouty diathesis, or even of a more serious condition still—incipient phthisis. ”

“ The kidneys are the individualized vascular system of the sex, as the liver is that for digestion. They accord with the liver in their glandular structure, in the renal pelvis, which is like the gall-cyst, in the ureters that resemble the biliary ducts, and lastly, in the general signification of the urine as a product, wherein the whole organism, the whole blood-system has been excreted, like the bile, in which the venous blood undergoes the same process. ”

“ A very common order is spleen, left adrenal and kidney, right adrenal and kidney, duodenum, stomach, pancreas, liver, intestines, pelvic organs and genitalia. Beneke advises the removal of spleen, then the removal of the entire intestines, stomach and pancreas, in connection with the gall-bladder, which is stripped from the liver and removed in connection with common duct and duodenum, the whole mass removed from the body and examined outside. ”

“ As to the tissues in the intestine which are primarily affected, it is impossible to make a definite statement. The muscle and glands cannot be at all separated from the complex nervous mechanism of the intestine, and it is necessary to take the whole as an organ made up of many tissues and affected in definite ways by certain solutions.
It is interesting in this connection to again note the effect of these salts on the secretion of urine. It is well known that practically all of them are diuretics, when introduced with a considerable amount of fluid. ”

“ The kidney may be ulcerated, and contain grubs, as well as the liver, it being likewise a gland, but much smaller than the liver. You can injure the kidneys by food, as all water or liquids go immediately to the kidneys; sweet spices and all acids should be avoided, as they coat the kidneys, and cause the gravel; the ureter, or pipe which takes the water to the bladder, finally gets filled and obstructed, so the water cannot pass thence. ”

“ Any change in the absolute amount of solid matter excreted in the urine must depend upon changes in the composition of the blood, or in the circulation of the blood through the kidneys, or in the structure of the kidneys themselves. All these three conditions seem to exist in Bright's disease, and either together or separately may diminish the daily excretion of solid matter. ”

“ As the organs within which these membranes are spread, are almost all susceptible of contraction and dilatation, as we see in the stomach, the intestines, the bladder, &c. it has been thought that during the dilatation, the vessels being more expanded, receive more blood, and that during the contraction on the contrary, being folded up, as it were choaked, they admit but a small quantity of this fluid which then flows into the neighbouring organs. ”

“ It provides points of value in diagnosis, prognosis, and treatment, being especially useful in nephritis, diabetes, acidosis, comatose conditions, gout, and in questions of renal function and treatment, especially dietetic. Urine findings are always dependent upon kidney function, and, by blood chemistry, we can pass behind this barrier. ”

“ The kidneys.—The kidneys are close to the backbone, below the heart. They are made of tiny tubes much like the sweat tubes in the skin. The tubes take ashes and other waste matters from the blood, also a great deal of water. They also take away poisons and disease germs when we are sick. The kidneys take away about as much water as the skin, but they get rid of very much more poisons and waste matters than the skin does. If our kidneys should stop their work, we should soon die. ”

“ Treatment. These urinary deposits indicate a general derangement of the system, as well as a local disease. Nutrition is imperfect and some of the excretory organs are not properly performing their functions, or, perhaps, some portion of the body is being too rapidly wasted. Very frequently we find these gravelly formations as the result of a rheumatic or a gouty diathesis. It is also a well-known fact that torpidity of the liver throws an excessive amount of work on the kidneys. ”

“ Valuable service is rendered to research as a whole, if every case, which gives an unexpected result in respect of its reaction, is thoroughly investigated. In the first place the dialysation tubes should be changed, or else another organ should be used. If the result always recurs, we still have to exclude the possibility that, in the organ used, substances are inherent which are also contained in other organs. In saying this we are thinking of such a case as the following. It may be that an individual has some diseased connective tissue in some part of his body. ”