106 PRACTICE OF MEDICINE. 



Pathology. — This state of the kidney is not an inflammation, but 

 a slow degeneration of structure^ commencing by an abnormal de- 

 posit of fat in the epithelium cells lining the uriniferous tubes. It is 

 a degeneration, therefore, much allied to the tubercular deposit, or 

 to the fatty liver, common in phthisis, and may properly receive the . 

 name of the fatty kidney. It is a slow insidious disease, beginning 

 generally much further back than the patient is aware of. 



The uriniferous tubes become by degrees blocked up with an ex- 

 cessive accumulation of fatiy epithelium ; the result of this is, that 

 the tubes become dilated, so as to press on the portal plexus of veins 

 which surround them. The veins being thus compressed, the Mal- 

 pighian capillaries, which open into them, are unable to discharge 

 their contents, and so become distended with blood; and either allow 

 serum to exude from their walls, or else burst and admit the escape 

 of red particles and fibrine. As the accumulation goes on, portal 

 plexuses and uriniferous tubes become atrophied, and hence, shrink- 

 ing of the kidney and deficiency of secretion ensue. As, however, 

 some Malpighian tufts remain healthy, the secretion from these is 

 sometimes abundant, or even excessive. 



The morbid anatomy is thus described and explained by Dr. 

 Todd :— 



1. "Both kidneys are found in a diseased state. It seldom or 

 never happens that the disease is limited to one kidney. 



2. " We meet with irregular vascular congestion, the vessels are 

 full at some parts of the organ, and empty at others, and this gives 

 rise to a mottled appearance on the surface of the kidney. 



3. " A deposit of a new matter is found either in or between the 

 tubes of the kidney; this deposit has hitherto been called granular. 



4. " As the disease advances, the kidneys, which at first were 

 enlarged, shrink, their cortical or external portion becoming wasted, 

 here and there leaving depressions on the surface of the organ, cor- 

 responding to the wasted portions ; and thus a tuberculated aspect is 

 given to the kidney. The blood-vessels are obliterated in many situa- 

 tions, and it is impossible to inject such kidneys." 



Cofistitutional Symptoms. — These may be divided into three 

 stages. 



In the first, the patient is weak and dyspeptic ; and his blood loses 

 its red particles in an extraordinary degree; but there is very little 

 to call attention to the kidney. 



In the second stage, the symptoms are, a pallid pasty complexion ; 

 dry hard skin; drowsiness; weakness; indigestion; and frequent 

 nausea; often retching the first thing in the morning; and palpita- 

 tion of the heart. A most characteristic symptom 4s, that the patient 

 is awakened once or twice in the night, with desire to make water. 



In the third stage, if the patient is exposed to cold, the kidney 

 becomes congested ; anasarca, with, perhaps, ascites, makes its ap- 



