256 



REN. 



Another fact confirmatory of Mr. Bow- 

 man's theory has been observed by myself.* 

 In examining the kidneys of persons who had 

 died jaundiced, and in whose urine there had 

 been a large quantity of bile, I observed 

 that the tubes were stained of a deep yellow 

 colour by the bile in their epithelical cells, 

 and that this yellow colour ceased abruptly at 

 the neck of the Malpighian capsule, and in no 

 instance did it affect any part of the tissue of 

 the Malpighian bodies. There are certain 

 other pathological phenomena, which Mr. 

 Bowman's theory very much assists to explain, 

 and which in their turn afford important evi- 

 dence in support of the doctrine in question. 



The office of secreting the solids of the 

 urine is limited to the convoluted portions of 

 the tubes. The straight tubes of the pyra- 

 mids probably have no secreting power, but 

 act merely as excretory ducts to convey the 

 secreted products from the cortical portion of 

 the gland. The different function of these 

 two portions of the tubes is sufficiently mani- 

 fested by two facts : 1st. By the difference 

 in the character of their epithelial lining ; 

 2dly. By the fact, that when the cortical por- 

 tion of the kidney is the seat of a morbid 

 deposit in consequence of the attempted ex- 

 cretion of abnormal products by the epithe- 

 lial cells in the convoluted tubes, the medul- 

 lary portion of the gland is very commonly 

 free from all trace of the same morbid deposit. 

 This is very frequently observed in instances 

 of fatty degeneration, as well as in the earlier 

 stages of the inflammatory diseases of the 

 kidney. 



PART III. PATHOLOGY OF THE KIDNEY. 



It will not be possible within the limits of this 

 article to give more than an outline of the pa- 

 thology of the kidney. The subject is one of 

 such great interest and importance that it re- 

 quires a much more extended consideration 

 than can here be assigned to it. 



The diseases of the kidney may be arranged 

 in two distinct classes: the first class including 

 those which are the result of some cause acting 

 locally, such as retention of the urine in con- 

 sequence of stricture, the mechanical irritation 

 of a stone impacted in the kidney, or a blow on 

 the loins ; while in the second class are in- 

 cluded those diseases which are the result of 

 a constitutional cause which acts upon the 

 kidney by inducing an abnormal condition of 

 the blood. 



We shall allude very briefly to the first 

 class of diseases, and then proceed to the con- 

 sideration of those diseases to which the kid- 

 ney is liable in consequence of a deteriorated 

 condition of the blood. 



Disease of the kidney from retention of urine. 

 Fig. 165. represents a condition of the kid- 

 ney which commonly results from an im- 

 peded escape of the urine. The ureter pelvis 

 and infundibula become much dilated, and 

 the cortical substance expanded and lobular 

 on the surface, the depressions between the 



* Med. Cliir. Trans, vol. xxx. 



lobules resulting from the binding down of 

 the tissue by the interlobular septa, in the 



Fig. 165. 



Section of the kidnej'- from a patient who had 

 stricture. The pelvis and infundibula are much di- 

 lated, the cortical portion is expanded, and its surface 

 lobular. The parts are reduced about one third 

 in the drawing. . 



intervals of which the glandular structure is 

 protruded by the distending force from within. 

 The mucous membrane frequently becomes 

 ulcerated, inflammatory deposits occur in the 

 substance of the kidney, and so the gland is 

 destroyed by a slow atrophy, or more rapidly 

 by suppurative inflammation. Both kidneys 

 are usually affected, .but in different degrees. 

 On a microscopical examination of the kid- 

 ney thus diseased, pus and other inflammatory 

 deposits are found. The deposits are not 

 confined to the tubes, but they occur irregu- 

 larly throughout the gland, so as in many 

 instances to obliterate all appearance of tubu- 

 lar structure. 



Disease of the liidnei/ from renal calculi. 

 When a calculus forms in the kidney, it may 

 lead to very different results according to its 

 size and position. If of small size, it may 

 pass down the ureter and so get into the 

 bladder ; or if it be too large to pass through 

 the ureter, it may, by becoming impacted in 

 the canal, and so obstructing the flow of 

 urine, give rise to a rapidly destructive sup- 

 purative inflammation, or it may lead to com- 

 plete atrophy of the gland. It sometimes 

 happens that several calculi become impacted 

 in the pelvis of one or both kidneys, causing 

 ulceration of the surrounding tissue, and 

 leading in some instances to a complete dis- 

 organisation of the gland. 



