REN. 



263 



a fatal termination. It is therefore as import- 

 ant to distinguish between acute or chronic 

 nephritis and fatty degeneration of the kidne)' 

 as it is to distinguish acute pneumonia or 

 chronic bronchitis from tubercular disease of 

 the lung ; and the diagnosis of the renal disease 

 may be made with as much ease and certainty 

 by a microscopical examination of the urine as 

 that of the pulmonary disease by auscultation 

 and percussion of the chest. 



The three forms of disease just alluded to, 

 viz. acute and chronic desquamative nephritis, 

 and fatty degeneration of the kidney, include 

 the greater number of those cases to which the 

 term " Bright's disease" is commonly applied. 

 On an inspection of the plates in the 1st 

 vol. of Dr. Bright's well known Medical Re- 

 ports, it is evident that more than one form of 

 disease is there described by that distinguished 

 physician. In a paper published two years 

 since*, I maintained that the term Bright's 

 disease should be confined to those cases in 

 which there is fatty degeneration of the 

 kidney, but after a further consideration of the 

 subject, I am of opinion that if the expres- 

 sion " Bright's disease" is retained it should 

 be used only as a generic term to include 

 several diseases, the existence and the im- 

 portance of which were first made known by 

 Dr. Bright. In order to convey a precise idea 

 of the particular form of Bright's disease al- 

 luded to, it is clearly necessary to use some 

 terms having a more definite meaning, and I 

 have suggested some which appear sufficiently 

 expressive for the purpose. 



Hydatids are occasionally found in the 

 kidney. Dr. Baillief was well aware of the 

 distinction between true hydatid cysts as 

 they are found in the kidney and the more 

 common serous cysts, which he correctly 

 supposed to arise from an expansion of some 

 of the natural tissues of the kidney. He 

 mentions one case of hydatids in the kidney, in 

 which there was a discharge of these bodes with 

 the urine. It is probable that in every case 

 of hydatid disease of the kidney, the nature of 

 the affection might be ascertained by a careful 

 examination of the urine. I have already 

 stated that if Mr. Simon's account of the 

 common serous cysts were a correct one, 

 they would be in fact hydatid cysts, and as 

 they would continually escape with the urine, 

 they might be detected by a microscopical 

 examination of the liquid. Assuming, how- 

 ever, that they are dilatations of the tubes, it 

 is not surprising that they should never be 

 found in the urine, and that they cannot be 

 dissected out from the kidney after death. 



Cancer of the kidney is less uncommon 

 than it was formerly supposed to be. It is 

 rarely limited to the kidney, and in the great 

 majority of cases, where other parts are im- 

 plicated, the disease has obviously originated 

 in some one or other of these parts. Can- 



* Mecl. Chir. Trans, vol. xxix. 



f The Morbid Anatomy of the Human Body. By 

 Matthew Baillie, M.D. 



J The Nature and Treatment of Cancer. By 

 Walter Hayle Walshe, M.D. 



cer less frequently affects the bladder and 

 kidney simultaneously than might be ex- 

 pected. M. Rayer and Dr. Walshe have ob- 

 served the frequent co-existence of cancer of 

 the liver and right kidney, and of the adjacent 

 parts of the stomach on the descending colon 

 and the left kidney. 



In thirty-six of the cases collected by Dr. 

 Walshe, the anatomical state is described 

 with considerable accuracy. " In thirty-one 

 of these, pure encephaloid or one of its va- 

 rities, was the species of cancer observed ; 

 scirrhus in five only, two of them of doubt- 

 ful character ; while colloid did not, in any 

 instance, occur in this situation. Encepha- 

 loid exhibits itself in all degrees of consis- 

 tence, and in several of its varieties. Among 

 these varieties, the hasmatoid may almost be 

 considered frequent, as compared with its 

 rarity in other internal organs. Encephaloid 

 occurs in the infiltrated and tuberous forms ; 

 the former more especially when the disease 

 is primary, the latter when secondary. Can- 

 cerous infiltration (as organic diseases gene- 

 rally) commences in the cortical substance. 

 This structure may, in some instances, dis- 

 appear altogether under the influence of the 

 accumulating cancerous matter, without the 

 tubular substances having suffered in the 

 least. The nodular form of the affection like- 

 wise originates in the cortical substance, ge- 

 nerally near the surface ; as the masses en- 

 large, they become prominent on the surface, 

 and assume the appearance of having formed 

 between the surface of the kidney and its 

 capsule." The renal tissue between the can- 

 cerous masses is sometimes quite healthy ; 

 but in other instances it is congested, in- 

 flamed, or actually in a state of suppuration, 

 the pus being infiltrated or accumulated in 

 a single spot. Melanotic discolouration of the 

 cancerous masses is occasionally, but rarely, 

 witnessed in the kidney. In thirty-five cases 

 of renal cancer, the disease affected both 

 organs sixteen times ; the right alone thirteen 

 times, the left alone six.* 



In concluding this brief sketch of the 

 pathology of the kidney, I will venture to 

 predict that, within a very short space of 

 time, the diseases of the kidney will be 

 more completely and generally understood 

 with reference to their pathology, diagnosis 

 and treatment than those of any other 

 organ. There are two circumstances which 

 justify such an anticipation : 1. There 

 is perhaps no important organ in the body 

 whose minute structure has been so com- 

 pletely and so clearly demonstrated as that of 

 the kidney has been by Mr. Bowman. And 

 2nd, The morbid deposits or accumulations 

 to which the kidney is liable occur, almost 

 without exception, in such a situation, within 

 the uriniferous tubes, that portions of 

 these materials are being continually washed 

 out by the stream of liquid which is poured 

 into the extremities of the tubes, and so they 

 come within the sphere of our daily obser- 



Dr. Walshe. Op. c it. 



s 4- 



