NEPHRITIS — INFLA3IMATI0X OF THE KIDNEYS. 725 



the vessels, partially fibrillating in the tubes and entangling 

 amongst the formed material the changing epithelium of the 

 tubes, in which form these fibrinous and epithelial casts appear 

 in the urine. 



h. Chronic Tubal Nephritis. — Besides this form of acute 

 inflammation of the tubular and vascular structures associated 

 with albuminous urine we sometimes encounter an apparently 

 less alarming, because less pronounced, but steadily progres- 

 sive and much more destructive diseased action affecting the 

 same and other textures of the kidneys, a subacute or chronic 

 tubal nephritis. 



This condition may follow an attack of the decidedly acute 

 form, or it may be developed independently of it ; it may also 

 be associated with conditions of fatty or lardaceous change 

 in the kidne3's, and with arterial capillary fibrosis here and in 

 other important organs. 



These extensive and serious structural changes in our 

 patients are rarely brought under our notice until considerable 

 inroad has been made in many structures, and until the 

 general health and constitutional vigour is completely under- 

 mined. 



Anatomical Characters. — In the one form, where the renal 

 disturbance is rapidly developed and in association with some 

 distinct and recognised blood-contamination, the kidney is 

 enlarged, rather wanting in consistence, and sometimes pale in 

 colour, at others rather darker ; when of the former character 

 the cortical structure particularly is, on a clean section being 

 made, seen marked with hsemorrhagic spots. More carefully 

 examined, the capillary system is seen somewhat congested ; 

 the urine-tubes are either filled and swollen, or their existence 

 is indistinguishable, several seeming massed together from 

 the amount of adventitious material connected with them, 

 material effused outside the tubes and augmented by increased 

 growth of cell- elements within. 



In the other and less active form there is a disposition 

 to lessening of size, with a somewhat contracted character 

 of the surface ; the main feature, however, being rather a pro- 

 duction of interconnective fibroid material existing around 

 the minute tubes and the glomeruli, wliich by its presence 

 seems to impair the extent and existence of these conduits, 



