A system of practical medicine. By American authors. Vol. 4

by Unknown

⁴ Stomach and Renal Diseases, 4th ed., London, 1843.

⁵ Lectures on Pathology and Therapeutics, 1868, p. 256.

⁶ Med.-Chir. Trans., vol. xiv. p. 221, 1862.

The results of examination of the blood, in cases of chylous urine, by Bence Jones, Rayer, and Crevaux, who found in certain instances an excess of fat, have been quoted in support of these views, but these examinations seem to have been microscopical and not chemical, and the results have not been confirmed by recent observers. Such views were also upheld on theoretical grounds by Bouchardat,⁷ based on the greater commonness of the disease in warm climates. He reasoned that when the heat-producing elements, whether absorbed from food or produced by metamorphoses of other proximate principles, are in excess, and an elevated external temperature does not favor their consumption, their elimination is attempted by certain organs, notably the liver and kidneys. The effort by the kidneys seems, however, to be attended by a structural change in the blood-vessels, as the result of which blood is eliminated with fat, especially at the beginning of the disease. Later the blood disappears, but the albumen remains some time longer, disappearing finally with the fat.

⁷ Ann. de Thérapeutique, 1862.

Bernard and Robin also compared the blood of such cases to that of geese artificially fattened, being that condition of blood which is normal after digestion but transient. Egel also held similar views, ascribing the imperfect elaboration to the effect of hot climates.

Gubler⁸ first suggested that chylous urine was due to a passage of chyle directly into the urinary passages, and that this was immediately preceded by a dilatation of the renal lymphatics similar to that known to occur on the surface of the body and attended by the local flow alluded to.

⁸ Gazette médicale de Paris, 1858, p. 646.

Vandyke Carter,⁹ of Bombay, suggested that the communication was between the lacteals and lymphatics of the lumbar region and those of the kidney. Those who have seen the semi-diagrammatic drawing of a dissection of the lymphatics as seen from behind, in the remarkable case of Stephen Mackenzie,¹⁰ cannot fail to be impressed with the probability of such communication.

⁹ Med.-Chir. Trans., vol. xlv., 1862.