THE URINARY ORGANS. 639 



SYPHILITIC INFLAMMATION. 



Gummata of the kidney are of occasional occurrence. A close rela- 

 tionship between syphilitic arteritis and atrophied forms of chronic dif- 

 fuse nephritis seems probable. 1 



STJPPURATIVE PYELITIS AND PYELO-NEPHBITIS. 



Suppurative Pyelitis is often associated with suppuration of the kid- 

 ney substance, more frequently, with a similar process in the bladder or 

 ureters. But it may occur by itself. It is incited by the same micro- 

 organisms as are concerned in the induction of the associated lesions in 

 the kidney and bladder ; in the latter case, it is most often the Bacillus 

 coli coniinunis, the Streptococcus pyogenes, and Staphylococcus pyogenes. 



The mucous membrane of the pelvis may be congested, thicker and 

 more opaque than normal, and coated with pus or with patches of fibrin. 

 The presence of pelvic calculi is to be regarded as a predisposing rather 

 than as a direct inciting agent in suppurative pyelitis. 



Suppurative Ureteritis. The conditions under which suppurative in- 

 flammation of the ureter occurs are similar, as is the general appearance 

 of its mucous membrane, to those just indicated in the pelvis. 



FIG. 400. CHROXIC PYELO-XKPHKITIS. 

 Showing dilatation of the pelvis and calyces. 



Suppurative Pyelo-Nephritis with Cystitis. In this association of lesions 

 of the bladder and kidneys, which is usually initiated by the inflamma- 

 tion of the bladder, the affection of the kidneys is commonly bilateral. 

 The suppurative areas in the kidney may be in the form of small ab- 

 scesses scattered through the kidneys, or in the form of elongated whitish 

 streaks or wedges between the tubules (see Fig. 384). The purulent foci 

 are often surrounded by a red zone of congestion. 



1 For bibliography see Delaware. Gaz. d. Hopitaux. May 12th, 1900. 



