The Croonian Lectures on the Influence of the Circulation upon the Nervous System
Authors: W. Moxon
Journal: BMJ (1881)

In I859, we find Traube, in his A7insische Untersuchuntgen (page 969), noticing the association of amyloid degeneration of the kidney with albuminous urine.Renal casts passed in the urine during life, and plugs loaded with fatty detritus were found blocking the tubuli uriniferi after death.The kidney presented a waxy appearance; the degenerative change was nearly entirely confined to the blood-vessels ; no appearances suggestive of parenchymatous inflammation were perceived, or led him to attribute the plugs or casts to active changes of or in the renal epithelium.Fatty degeneration of the renal epithelium might, therefore, be induced by other causes besides inflammation; and in amyloid, perhaps, as in some other cases, should be attributed to a kind of necrosis.Casts, as Frerichs had shown, neither by their size, nor their quantity, nor their characters-whether full of cells, or of fat, or of granular matter, or of blood-cells-could be accepted as evidence of the actual state of the kidney; although there was a great unanimity of opinion among observers that fatty casts were signs of ill-omen, and that sediments, which contained large hyaline casts, and numerous white (or compound granular) cells, associated with botryoidal clusters of free nuclei (vide Dr. Basham, fourth edition, page 130), usually indicated a most intractable, because most widely diffused, form of renal degeneration.Differentiation was the order of the day; the pendulum which Frerichs had forced back to Bright's last-issued idea, that his disease was, essentially and pathologically one, interrupted by death, and thus encountered at different stages, was swaying, irresistibly swaying, in an opposite direction.Beer, in his work on the connective tissue of the human kidney, published in I859, was calling attention to two distinct forms. of interstitial hyperplasia, which he had observed in renal disease: the one circumglomerular, the other intertubular.The circumglomerular interstitial nephritis was, according to him, marked clinically by yellowcoloured urine, of low specific gravity, and presenting little urinary sediment ; whereas the intertubular commenced with hbematuria, and was attended by urine of high specific gravity, and possessing much sediment.-Traube writes in i86o (A7linischze Vntersuchungen, page 969), ap- pealing that the name of Bright's disease should be given up, because it promulgated error, and led to the confusion together under one head of a great variety of forms of renal degeneration; the parenchyma- tous inflammation did not constitute it; this was a first change only, which might lead to it.Interstitial nephritis, or interstitial hyperplasia, could be developed without any, previous stage of parenchyma- tous -swelling; and parenchymatous swelling was to be found in the renal changes secondary to old heart-affections.Typical parenchymatous swelling existed in the kidney of variola, and in all other acute febrile processes; but this did not necessarily go on to degenerative renal disease.At the same time, he admitted that glandular or parenchymatous swelling of the epithelium of the cortical tubes was an ordinary accompaniment of interstitial nephritis, and of amyloid disease of the vessels of the kidney.Acts of Parliament and the Oueen's pleasure apart, there are few things so difficult to shake yourself quit of as the name of a place, or of a man, or of a disease.While Traube was urging that the name of Bright's disease should be surrendered, because of its vagueness and uncertain applicability, Dr. Goodfellow, in some admirable Lectures on *Diseases of the Kidney, published in i86I, was as strongly recommending its re-adoption in England, in lieu of albuminuria, for a varied but peculiar (Specific) renal degeneration, which possessed certain well ascertained