728 DISEASES OF THE KIDNEYS. 



the inflammatory products are largo in amount and extensively 

 diffused, cell-proliferation and growth being active, with cell- 

 secretion largely lessened, suppurative inflammation may be 

 established, or other changes of a permanent and degenerative 

 character occur. In the majority of these cases, besides the 

 distinct involvement of the parenchymatous and interstitial 

 structure of the gland, Ave often observe that the lining mem- 

 brane of the pelvis gives evidence of the same disturbance. 



'Causation. — (1) Direct local injury resulting from violence, 

 inflicted as blows, or long-continued and badly-disposed weight ; 



(2) Laceration, or damage sustained by muscular or other tissue 

 in the lumbar region from excessive or prolonged exertion, the 

 eflects of which are propagated from contiguity to the kidneys ; 



(3) Cold and moisture, in the form of rain, applied directly to 

 the loins, particularly following fatigue and exertion ; (4) The 

 ingestion or absorption of certain irritating materials, as 

 turpentine or cantharides ; (5) The presence of a calculus in 

 the pelvis of the kidney. 



Anatomical Characters. — When examined while the action 

 is at its height, and before ulterior changes of either a fatty 

 or fibroid character are established, the kidney is found enlarged, 

 distinctly hypergemic, with variously distributed hsemorrhagic 

 markings, particularly in the cortical substance. In many 

 instances puriform material exists in connection with the mem- 

 brane of the pelvis and calices, while there is frequently 

 encountered distinct circumscribed abscesses, sometimes of 

 considerable size, oftener small, and scattered through the struc- 

 ture, but disposed to enlarge by coalescing. These abscesses 

 will in some instances be found to have ruptured probably 

 previous to death, discharging purulent matter and blood into 

 the pelvis of the organ. 



Symptoms. — These are usually rapid in development, and so 

 closely linked to the immediately inducing cause, that without 

 any stretch of imagination we at once connect the two in their 

 natural and proper position of cause and effect. As many of 

 the symptoms of colic are present, the marked exhibition of 

 abdominal pain may induce us to suppose that the digestive 

 canal is the seat of the disturbance ; from bowel disturbance^ 

 however, this is so far different, that in the affection of the 

 kidneys we have marked pyrexia which, as a rule, does not 



