400 HERMAN O. MOSENTHAL 



our knowledge concerning any sign, such as blood pressure, in this form 

 of Bright's disease must necessarily be inconclusive. 



Janeway found some of these cases to have extremely high blood pres- 

 sure ; Roth observed some without any increase in arterial pressure. The 

 records have fluctuated between these two extremes. Most instances of 

 true secondary contracted kidney which the author has examined have 

 had a slight hypertension, the blood pressure usually being between 160 

 and 180, and frequently dropping to a normal level with rest in bed. It 

 is probable that one of the distinguishing features of this form of con- 

 tracted kidney is the comparatively low arterial pressure. 



Essential Hypertension and Primary Contracted Kidney. One of 

 the most important facts in clinical medicine that has been developed 

 within the last decade is that the most frequent and marked examples 

 of arterial hypertension occur in the absence of any renal involvement. 

 It is to the credit of Sir Clifford Allbutt(a), more than to any other one 

 man, that this has been established. His clinical studies have been amply 

 borne out since tests for renal function came to be applied to this problem. 

 It is a daily experience to find patients whose systolic pressure ranges be- 

 tween 200 and 250 mm. of mercury and whose kidneys are normal to all 

 the usual tests for renal efficiency. As time passes the strain upon the 

 arterial system results in arteriosclerosis. Among other organs, the kidneys 

 become affected and arteriosclerotic kidneys are the almost invariable 

 finding in such cases. Such postmortem evidences were regarded as proof 

 of the causative relation of a primary contracted kidney to hypertension. 

 However, the clinical studies, as briefly outlined above, indicate clearly 

 that the cart has been put before the horse and that, the hypertension is the 

 primary factor. , 



Some of the older anatomical findings in regard to this condition are 

 of extreme interest. They have been duplicated frequently and may be 

 regarded as correct Jores demonstrated that a marked degree of arterio- 

 sclerotic kidney may be present and not be accompanied by hypertension 

 (Jores, Krehl, Janeway, Schlayer). The opposite apparently also holds 

 true: that an increased blood pressure may exist in the absence of any 

 kidney disease whatsoever; it is worth noting that the actual count of 

 the number of glomeruli destroyed bore no relation to the level of blood 

 pressure ( Jores (&) (c), 1908). Furthermore, as the late Theodore Jane- 

 way was very fond of insisting, the relation between a glomerular lesion 

 and hypertension must be very remote since a low blood pressure is charac- 

 teristic of amyloid disease, a condition in which the glomeruli are very 

 extensively involved. 



The problem of the relation of blood pressure to arteriosclerosis is too 

 far removed from the subject matter of this article to warrant its dis- 

 cussion in detail ; from what has been stated above it is perfectly evident, 

 however, that a contracted arteriosclerotic kidney will not result in in- 



