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THE ORIGIN AND NATURE OF GRANULAR AND HYALINE RENAL CASTS.
1487 Dec. 19th. Our Army’s Teeth, F. NEWLAND-PEDLEY, Dec. 19th. Discussions at the Medical Society of London on Surgical Experiences of the Present War, and on Treatment of Tetanus were reported in THE LANCET of Nov. 21st and 28th and Dec. 12th.
The outcome of all the communications which have received, as well as of those which have been published, is decidedly satisfactory as regards the general health of our own troops. The incidence among them of infectious disease has been small, almost infinitely smaller than some of the gloomier forecasts, and the treatment of the wounded has been undertaken in a systematic manner as soon as the military conditions of the campaign made this in the least possible. The work of the Royal Army Medical Corps has been splendid, and the public cooperation generous and, as a rule, remarkably effective. The heroic remnant of the Belgian army has been sorely tried by sickness, as was only to be expected when the conditions under which it has struggled so fearlessly for nearly five months are recalled. Behind the vastly extended lines of our French Allies the number of sick has been in certain districts large, but the grave dangers of widespread infection have been met by strenuous organisation and personal devotion. Sufferings which no words can describe have been endured, and remain for endurance, but from the medical point of view the story is satisfactory and the outlook hopeful. we
Annotations. "Ne quid nimis."
THE ORIGIN
AND NATURE OF GRANULAR AND HYALINE RENAL CASTS.
THERE is a well-known disparity of opinion with to the origin and composition of renal casts. Rovida and Padoa consider granular casts the products of a secretion of altered epithelial cells in the renal tubes, while Senator and Olivero believe that they originate by a process of transformation of necrosed epithelium. Hyaline casts have been of as a regarded product epithelial secretion or as formed by albumin exuded from the glomeruli and coagulated in the tubules. An experimental note on the subject has just been published in Il Policlinico for Nov. 29th by Dr. Cesare Minerbi, who has availed himself of a new method of staining urinary sediments discovered by W. Vecchiati by using Pappenheim’s solution. By this process the epithelial cells of the tubules, whether free or as epithelial casts, take a bright sky-blue tint, faintly violet in the protoplasm, reddish purple in the nucleus which is clearly mapped out. Granular casts also are coloured blue with a more or less tendency to violet. They show here and there included epithelial cells from the tubules, with their marked characteristics, although more or less altered, inasmuch as the protoplasm does not change colour, and the nucleus, although undergoing a chromatolysis more or less advanced, is perfectly recognisable. In sediments where there is a large quantity of granular casts it is easy to follow the phases of transformation from epithelial to granular casts. The process seems to be as follows. The cells fuse and agglutinate their protoplasm, the nucleus becomes a prey to chromatolysis, and disintegrates, its fragments being disseminated throughout the protoplasm and gradually dissolved. Such fragments assume under the
regard
staining described a colour no longer purplish but tending to yellowish brown. In this manner is produced a granular cast, formed in substance from the protoplasm of the epithelium of the tubules and containing granules which are partly " nuclear detritus and partly derived by the " lysis of the protoplasm. Hyaline casts only in rare instances take a faint pink stain; for the most part they remain absolutely colourless and there is never any evidence of any trace of nuclear debris. Commenting on this fact, Dr. Minerbi is of opinion that hyaline casts are derived from blood casts, the red cells of which lose their hasmoglobin under the influence of the hypotonic solvent action of the urine. ____
Dr. F. Gowland Hopkins, F.R.S., university reader in chemical physiology, has been elected to the newly constituted professorship of biochemistry in the University of Cambridge.
a DONATIONS AND number of charitable gifts left by the late Miss Julia Crokat are 91000 each to St. Mary’s Hospital, the Hospital for Sick Children, Great Ormond-street, and 9500 each to the British Home for Incurables and to the Royal Hospital for Incurables.-The Royal Dental Hospital, Leicestersquare, has received a donation of .BI000 from Mr. Somerset Beaumont.
BEQUESTS.-Among
CENTRAL MIDWIVES BOARD.-A
large
special meeting
of the Central Midwives Board was held at Caxton House, Westminster, on Dec. 15th, Sir Francis H. Champneys being in the chair. A number of midwives were struck off the roll, the following charges amongst others having been brought forward : Not observing the antiseptic precautions prescribed by Rules E. 3 and 7 ; persistently neglecting and refusing to give reasonable facilities for the inspection by the local supervising authority of the register of cases, bag of appliances, and place of residence, and an investigation of the mode of practice, as required by Rule E. 24. Neglecting to adopt the antiseptic precautions required by Rules E. 3 and 7, and to take and record the pulse and temperature of the patient, as required by Rule E. 13. Medical aid having been sought, the midwife neglected to notify the local supervising authority thereof, as required by Rule E. 21 (1); not being scrupulously clean, as required by Rule E. 1 ; not cleansing the eyelids of the child in accordance with Rule E. 15, and being unable to take the pulse or temperature of patients, and in consequence being unable to comply with Rule E. 13. That being in attendance as a midwife at a confinement and the child suffering from inflammation of and discharge from the eyes, the midwife did not explain that the case was one in which the attendance of a registered medical practitioner was required, nor did she hand to the husband or the nearest relative or friend present the form of sending for medical help, properly filled up and signed by her, in order that this might be immediately forwarded to the medical practitioner, as required by Rule E. 20 (5). The midwife attending a confinement not wearing a clean dress of washable material, as required by Rule E. 1, and not taking to the confinement the appliances and antiseptics prescribed by Rule E. 2.-At a meeting of the Board at Caxton House, on Dec. 17th, Sir Francis Champneys being in the chair, a letter was considered from the Secretary of the Association for Promoting the Training and Supply of Midwives transmitting for the information of the Board returns obtained by the association from local supervising authorities as to the difficulty experienced in obtaining the services of a registered medical practitioner when summoned in emergencies on the advice of The Board directed that the association be a midwife. informed that the Board sympathises with it, and has repeatedly urged the necessity of securing the payment of medical practitioners when summoned to cases in charge of midwives, and that the Board will use its endeavours at the proper time to get such a clause passed, and further suggests that the association should use their influence to get an amending Bill passed as soon as possible.
The outcome of all the communications which have received, as well as of those which have been published, is decidedly satisfactory as regards the general health of our own troops. The incidence among them of infectious disease has been small, almost infinitely smaller than some of the gloomier forecasts, and the treatment of the wounded has been undertaken in a systematic manner as soon as the military conditions of the campaign made this in the least possible. The work of the Royal Army Medical Corps has been splendid, and the public cooperation generous and, as a rule, remarkably effective. The heroic remnant of the Belgian army has been sorely tried by sickness, as was only to be expected when the conditions under which it has struggled so fearlessly for nearly five months are recalled. Behind the vastly extended lines of our French Allies the number of sick has been in certain districts large, but the grave dangers of widespread infection have been met by strenuous organisation and personal devotion. Sufferings which no words can describe have been endured, and remain for endurance, but from the medical point of view the story is satisfactory and the outlook hopeful. we
Annotations. "Ne quid nimis."
THE ORIGIN
AND NATURE OF GRANULAR AND HYALINE RENAL CASTS.
THERE is a well-known disparity of opinion with to the origin and composition of renal casts. Rovida and Padoa consider granular casts the products of a secretion of altered epithelial cells in the renal tubes, while Senator and Olivero believe that they originate by a process of transformation of necrosed epithelium. Hyaline casts have been of as a regarded product epithelial secretion or as formed by albumin exuded from the glomeruli and coagulated in the tubules. An experimental note on the subject has just been published in Il Policlinico for Nov. 29th by Dr. Cesare Minerbi, who has availed himself of a new method of staining urinary sediments discovered by W. Vecchiati by using Pappenheim’s solution. By this process the epithelial cells of the tubules, whether free or as epithelial casts, take a bright sky-blue tint, faintly violet in the protoplasm, reddish purple in the nucleus which is clearly mapped out. Granular casts also are coloured blue with a more or less tendency to violet. They show here and there included epithelial cells from the tubules, with their marked characteristics, although more or less altered, inasmuch as the protoplasm does not change colour, and the nucleus, although undergoing a chromatolysis more or less advanced, is perfectly recognisable. In sediments where there is a large quantity of granular casts it is easy to follow the phases of transformation from epithelial to granular casts. The process seems to be as follows. The cells fuse and agglutinate their protoplasm, the nucleus becomes a prey to chromatolysis, and disintegrates, its fragments being disseminated throughout the protoplasm and gradually dissolved. Such fragments assume under the
regard
staining described a colour no longer purplish but tending to yellowish brown. In this manner is produced a granular cast, formed in substance from the protoplasm of the epithelium of the tubules and containing granules which are partly " nuclear detritus and partly derived by the " lysis of the protoplasm. Hyaline casts only in rare instances take a faint pink stain; for the most part they remain absolutely colourless and there is never any evidence of any trace of nuclear debris. Commenting on this fact, Dr. Minerbi is of opinion that hyaline casts are derived from blood casts, the red cells of which lose their hasmoglobin under the influence of the hypotonic solvent action of the urine. ____
Dr. F. Gowland Hopkins, F.R.S., university reader in chemical physiology, has been elected to the newly constituted professorship of biochemistry in the University of Cambridge.
a DONATIONS AND number of charitable gifts left by the late Miss Julia Crokat are 91000 each to St. Mary’s Hospital, the Hospital for Sick Children, Great Ormond-street, and 9500 each to the British Home for Incurables and to the Royal Hospital for Incurables.-The Royal Dental Hospital, Leicestersquare, has received a donation of .BI000 from Mr. Somerset Beaumont.
BEQUESTS.-Among
CENTRAL MIDWIVES BOARD.-A
large
special meeting
of the Central Midwives Board was held at Caxton House, Westminster, on Dec. 15th, Sir Francis H. Champneys being in the chair. A number of midwives were struck off the roll, the following charges amongst others having been brought forward : Not observing the antiseptic precautions prescribed by Rules E. 3 and 7 ; persistently neglecting and refusing to give reasonable facilities for the inspection by the local supervising authority of the register of cases, bag of appliances, and place of residence, and an investigation of the mode of practice, as required by Rule E. 24. Neglecting to adopt the antiseptic precautions required by Rules E. 3 and 7, and to take and record the pulse and temperature of the patient, as required by Rule E. 13. Medical aid having been sought, the midwife neglected to notify the local supervising authority thereof, as required by Rule E. 21 (1); not being scrupulously clean, as required by Rule E. 1 ; not cleansing the eyelids of the child in accordance with Rule E. 15, and being unable to take the pulse or temperature of patients, and in consequence being unable to comply with Rule E. 13. That being in attendance as a midwife at a confinement and the child suffering from inflammation of and discharge from the eyes, the midwife did not explain that the case was one in which the attendance of a registered medical practitioner was required, nor did she hand to the husband or the nearest relative or friend present the form of sending for medical help, properly filled up and signed by her, in order that this might be immediately forwarded to the medical practitioner, as required by Rule E. 20 (5). The midwife attending a confinement not wearing a clean dress of washable material, as required by Rule E. 1, and not taking to the confinement the appliances and antiseptics prescribed by Rule E. 2.-At a meeting of the Board at Caxton House, on Dec. 17th, Sir Francis Champneys being in the chair, a letter was considered from the Secretary of the Association for Promoting the Training and Supply of Midwives transmitting for the information of the Board returns obtained by the association from local supervising authorities as to the difficulty experienced in obtaining the services of a registered medical practitioner when summoned in emergencies on the advice of The Board directed that the association be a midwife. informed that the Board sympathises with it, and has repeatedly urged the necessity of securing the payment of medical practitioners when summoned to cases in charge of midwives, and that the Board will use its endeavours at the proper time to get such a clause passed, and further suggests that the association should use their influence to get an amending Bill passed as soon as possible.