KIDNEYS, DISEASES OF. 



KIDNEYS, DISEASES OF. 



exceeding two years ; and if a male, to be once, twice, or thrice publicly 

 or privately whipped (if the court shall so think fit) in addition to such 

 imprisonment. 



The act does not extend to a person who shall have claimed to be 

 the father of an illegitimate child, or to have any right to the posses- 

 sion of such a child, on account of his getting possession of such child, 

 or taking it out of the possession of the child's mother, or other person 

 who has the lawful charge of it. The Irish act (10 Geo. IV., c. 34) is 

 in precisely similar terms. (Kerr's Blackstone and Russell on Crimes 

 by Greaves.) 



As to the conveying away of heiresses and young women, see 

 ABDUCTION. 



KIDNEYS, DISEASES OF. The principal disease to which the 

 kidneys are liable is that which gives rise to the formation of calculi. 

 [CALCULUS.] Sometimes the stone is retained hi the pelvis of the 

 kidney, where, by continued depositions, it may increase till it com- 

 pletely fills the pelvis and calyces; but more frequently it passes 

 through the ureters into the bladder, producing in its passage violent 

 spasmodic pain in the loins, sickness and nausea, haemorrhage, &c. 

 ffection is the moat common cause of inflammation of the kid- 

 nephritis), from which abscess and other morbid alterations may 

 result. 



An affection of the kidneys, having very definite symptoms, and 

 exhibiting uniformity of structural change, was first pointed out by 

 Dr. Bright of Guy's Hospital, and is generally called after him. This 

 disease U also called Albuminuria and granular disease of the kidney; 

 the first on account of its diagnostic symptom, albumen in the urine, 

 the second on account of the morbid condition presented by the 

 kidney. This formidable disease presents several stages or varieties, 

 and some discussion has taken place as to whether the symptom of 

 albumen in the urine may not occur in several distinct morbid con- 

 ditions of the kidney. There is no doubt that albumen may be found 

 in the urine in even functional derangements of the kidney ; but the 

 term liright's Disease is very conveniently applied to all those forms of 

 structural change in the kidney which are accompanied with albuminous 

 urine. 



The great symptoms accompanying this disease vary according to 

 the intensity of the disease and the condition of the patient. One of 

 the first symptoms to which the physician's attention is usually drawn, 

 is the presence of dropsy. This may occur in the skin or in any of the 

 cavities of the body. It is frequently noticed in the face ; and in all 

 varieties of this disease an effusion of fluid is observed underneath the 

 conjunctiva, producing the appearance of a watery eye. In addition to 

 al effusions, inflammatory affections of the mucous and serous 

 membranes are very common accompaniments of Bright's Disease. 

 The heart also is frequently affected, and pericarditis and endocarditis 

 are observed. Affections of the brain are also not unfrequently 

 present, especially in the more severe cases arising from the poisoned 

 condition of the blood. 



In all cases of this disease, the urine contains albumen. This is 

 easily detected either by coagulating the albumen by heat or nitric 

 acid. The specific gravity of the urine is also decreased, being some- 

 as low as I'OIO, whilst healthy urine has a specific gravity of 

 1'020. It contains less urea than healthy urine. Under the micro- 

 scope it also presents appearances indicative of the nature of the 



. These appearances consist of casts of the minute tir 

 tin- kidney*, formed by substances produced in various stages of the 

 . They are thus classified by Dr. Bennett : 



1. Ejrudative cattt, consisting of the coagulated exudation or fibrin 

 wliii ii is poured into the tube during the inflammatory stage. 



2. Desquamatire casts, consisting of masses of the epithelium lining 

 the tubes, and occurring in all stages of the disease. 



3. Patty casts, consisting of patches of epithelium as in the last, but 

 which have undergone a fatty transformation by the accumulation of a 

 greater or less number of fatty granules in its cells. 



4. Waxy casts, presenting an exceedingly diaphanous and structure- 

 less substance. They are frequently associated with the two last. 



Dr. Bright originally described three stages of this disease, but later 

 observers have recognised six. 



1. The catarrhal form, in which the kidneys are enlarged, an 



tain an increased quantity of blood. In this stage only a small quantity 

 of urine is passed, containing the exudative and disquamative casts. 



2. In this stage the kidney is enlarged to nearly double its size 

 and w white and granular in its appearance. The tubes of the 

 kidrv-y are obliterated by .the inflammatory deposit. The urine is 

 very albuminous, and of light specific gravity. 



3. The kidney presents a mottled appearance. It is probably a 

 transition from the first to the second stage. 



I. In thin stage the kidney is large, dense, and white. The tissues 

 <>f tin' kidney have become charged. The urine is scanty, of low- 

 lie gravity, and defective in urea and other excretory matters. 

 6. In this stage the kidney is hard, granular, and contracted. The 

 kiilnoy is smaller than in health, the surface is uneven and puckered, 

 at. There is no deposit in the tubes, but fibrous 

 r has Iwen de|.o.-it,i <1 in the tissues of the kidney, and the tubes 

 langulated. The urine may not contain albumen. Its specific 



n sometimes as, low as 1-005. 

 i liia stage has been called the ' coarse kidney.' The organ is 



large and dark. The specific gravity of the urine is high, and it is 

 loaded with urates. 



The presence of fatty matter in the casts of the kidneys may occur 

 in any of these stages, and does not appear to exist as a separate form 

 of the disease. 



The cause of this disease is anything which will unduly excite the 

 action of the kidney. Thus it comes on as the result of spirit drinking, 

 which powerfully excites the action of the kidneys. Exposure to cold 

 and diminution of the action of the skin will also produce it. It comes 

 on frequently after scarlatina, when the skin is highly susceptible of 

 any diminution of temperature. 



The treatment must be active in the early stages. Purgatives may 

 be given and blood abstracted locally, and the febrile symptoms treated 

 accordingly. Mercury is not found beneficial. When chronic, diapho- 

 retics and diuretics are both admissible. Amongst the former, Dover's 

 powder and warm baths, and the Litter, bitartrate of potash and 

 digitalis. The patient should be protected from cold ; a warm climate 

 is serviceable ; and a nutritious but not stimulating diet, with fresh 

 air and exercise, are desirable. 



The name of Dr. Addison, physician to Guy's Hospital, has been 

 connected with a diseased condition of the system, which is made 

 apparent by a discoloration of the skin. Hence this disease is also 

 called ' Bronzed Skin.' The existence of this discoloured skin has 

 long been known as a symptom' of certain cachectic states of the 

 system ; but Dr. Addison was the first to point out that this state of 

 the skin generally existed in connection with a diseased condition of 

 the supra-renal capsules. These bodies belong to the class of ductless 

 glands, and till the time of Dr. Addison's researches upon bronzed skin 

 appeared, little was known of their uses and functions in the human 

 body. The following conclusions with regard to these bodies have 

 been arrived at by Dr. Harley as the result of his experiments : 



1. The supra- renal capsules are not solely fcetal organs. 



2. They are not absolutely essential to life. 



3. The removal of the right is generally more fatal than the left. 



4. That convulsions do not necessarily follow their removal. 



5. The absence of their function is attended neither by great 

 emaciation nor debility. 



0. If death follows an experiment, it occurs as the resxdt of injuring 

 ncighlKjuring parts. 



7. Absence of the supra-renal bodies is not proved to have any 

 special effect in arresting the transformation of hicmatin, or in increasing 

 the formation of blood crystals. 



8. The suppression of the supra-renal capsular function is not 

 attended by an increased deposit of pigment in the skin or its 

 appendages. 



9. The problem of the connection of the bronzed skin and supra- 

 renal capsular disease is more likely to be solved in the dead-house 

 than in the physiological laboratory. 



These conclusions were chiefly arrived at by experiments on rats, 

 but they would seem to indicate that the connection between the 

 bronzed skin and supra-renal capsules is not clearly made out. 



The distinguishing features of the disease to which the name bronzed 

 skin has been given, are general languor and debility, great feebleness 

 of the heart's action, irritability of the stomach, a peculiar change of 

 colour of the skin, and these symptoms usually occurring in connection 

 with a diseased condition of the supra-renal capsules. The general 

 symptoms are in fact those of ana-mia, or cases in which the blood is 

 imperfectly developed. Dr. Ad'ii '! tys of this discoloration of the 

 skin, that it usually increases with the advance of the disease. " The 

 aiuemia, languor, failure of appetite, and feebleness of the heart become 

 aggravated ; a darkish streak usually appears upon the commissure of 

 the lips ; the body wastes, but without the extreme emaciation and 

 dry harsh condition of the surface so commonly observed in ordinary 

 malignant diseases ; the pulse becomes smaller and weaker, and with- 

 out any special complaint of pain or uneasiness, the patient at length 

 gradually sinks and expires. In one case, which may be said to have 

 been acute in its development as well as rapid in its course, and in 

 which both capsules were found universally diseased after death, the 

 mottled or checkered discoloration was very manifest, the antcmic 

 condition strongly marked, and the sickness and vomiting urgent ; but 

 the pulse, instead of being small and feeble as usual, was large, soft, 

 extremely compressible, and jerking on the slightest exertion or 

 emotion, and the patient speedily died." (Addison.) 



Although the connection between the state of the skin and the 

 disease of the capsules was exhibited in all Dr. Addison's original cases, 

 many exceptions have been recorded. . Cases have occurred in which 

 extensive disease of the supra-renal capsules has occurred without any 

 bronzed skin, and cases of bronzed skin have been seen where no 

 disease of the supra-renal capsules could be detected after death. 



Dr Harley, in the paper before referred to, concludes : 



1. That bronzed skin may exist without the supra-reual capsules 

 being diseased. 



2. That complete degeneration or total absence of the supra-renal 

 capsules may occur without any bronzing of the skin. 



3. That bronzed skin may be associated with a variety of differently 

 marked conditions of the system, among which a prominent one is 

 disease of the supra-renal capsules. 



i. That bronzed skin may be present without any derangement of 



