REN. 



257 



Disease of the kidney from external violence 

 is not of common occurrence. One case of 

 the kind has occurred to myself. A strong 

 man in robust health received a violent blow 

 on the loins from a bludgeon ; he suffered 

 much pain, and within a short time after the 

 receipt of the injury he had hsematuria. The 

 bleeding recurred at intervals during several 

 months, and was succeeded by a discharge of 

 purulent matter with the urine. The purulent 

 discharge continued for a period of more than a 

 year, when the poor man died much emaci- 

 ated. On a post mortem examination, the 

 right kidney was found completely destroyed by 

 suppurative inflammation ; there was no stru- 

 inous deposit in the kidney or in any other 

 organ. There was no calculus. The left 

 kidney was quite sound. 



Extension of disease from other organs to the 

 kidney. The kidney sometimes becomes in- 

 volved in malignant or other disease affect- 

 ing the intestines and other adjacent viscera. 

 Allusion has already been made to a prepa- 

 ration in the Museum of King's College, in 

 which there is a communication between an 

 abscess in the psoas muscle and the canal of 

 the ureter. 



Diseases resulting from a constitutional cause. 

 Scrofulous disease of the kidney occurs in 

 the form of small scattered deposits of tuber- 

 cular matter, or it presents itself in the form 

 of a thick curdy deposit which leads to the 

 formation of a large scrofulous abscess, the 

 cavity of which is subdivided by septa formed 

 by the thickened interlobular cellular tissue. 

 (Jig. 166.) The scrofulous deposit commonly 



Fie. 166. 



Scrofulous abscess in the kidney. The cavity of 

 the abscess is divided by septa, which are formed by 

 the interlobular cellular tissue, thickened by an in- 

 terstitial deposit of strumous matter. The glandular 

 structure has been destroyed by suppurative inflam- 

 mation. 



extends over the mucous membrane of the 

 ureter, which becomes much thickened. 



Acute suppurative nephritis is not a common 

 disease, but it is a very serious and a very 

 fatal one. In one case it supervened upon 



VOL. IV. 



chronic disease of the kidney, in consequence 

 of the intemperate use of fermented liquors 

 by a man whose general health was much dis- 

 ordered, and who had been subject for several 

 months to successive crops of boils and car- 

 buncles about the neck and shoulders. He 

 died in about a week after symptoms of sup- 

 purative nephritis had manifested themselves. 

 The nature of the disease was detected at the 

 very commencement by a microscopical exa- 

 mination of the urine (jig. 167). Both kidneys 



Fig. 167. 



Deposit in the urine of a patient labouring under 

 acute suppurative nephritis, a, crystals of triple 

 phosphate ; b, c, d, moulds from the tubes of the 

 kidney, the last entangling pus corpuscles. Some 

 free pus corpuscles are scattered about the field. 

 Magnified 200 diameters. 



were much enlarged, evidently from a recent 

 attack of acute inflammation, numerous small 

 points of suppuration were scattered through 

 them, and the left contained two large recent 

 abscesses. This case occurred in King's Col- 

 lege Hospital, under the care of Dr. Todd. 



Acute desquamative nephritis. This form of 

 disease occurs very frequently as a conse- 

 quence of scarlatina, and is occasionally pro- 

 duced by other animal poisons, as for instance 

 that of typhus fever, small-pox, or measles. 

 The same condition of kidney very commonly 

 occurs amongst the poor in large towns and 

 elsewhere, as a consequence of that deterior- 

 ated condition of the blood, which results from 

 an insufficient supply of animal food ; and it 

 sometimes occurs as a consequence probably 

 of a similarly deteriorated condition of the 

 blood in persons who are much reduced by 

 long-continued disease, as for instance secon- 

 dary syphilis or chronic abscess. 



The kidney in these cases is enlarged, ap- 

 parently by the deposit of a white material in 

 the cortical substance ; the vessels in the 

 cortical portion where they are not compressed 

 by this new material, are injected, and of a 

 bright red hue ; the medullary cones are of a 

 dark red colour, in consequence of the large 

 veins which occupy these portions of the 

 gland being distended with blood. The ap- 



