12 DISEASES OF THE KIDXEF. 



exhibit any important change in the texture of the kidney. The 

 glomeruli, being overloaded with blood, are very distinct. Extravasa 

 tions of blood are almost always found in the Malpighian capsules and 

 tubules, which account for the blood-red points above alluded to. 

 There are likewise extravasations between the albuginea and the tu- 

 bules. The uriniferous tubules, especially those of the cortical sub- 

 stance, are filled with coagulated exudation. Upon microscopic ex- 

 amination of the liquid expressed from the cut surface of the diseased 

 kidney, we find the cylindrical masses of exudation covered with epi- 

 thelium and blood-corpuscles, forming casts of the tubules. The epi 

 t helium is not materially altered, only moderately swollen and clouded, 

 SYMPTOMS AND COURSE. Sometimes croupous nephritis is ushered 

 in by a rigor, followed by fever and a sharp pain in the region of the 

 kidney. In addition to this, there is almost always more or less 

 violent (sympathetic) vomiting ; indeed, vomiting is a more constant 

 token of incipient disease of the kidney than either fever or pain, and 

 it is well to warn parents of children with scarlatina of the serious 

 nature of this symptom, and to require them to seek medical aid 

 should it arise. The patient feels a constant inclination to pass water, 

 but is unable to expel more than a few drops with each effort. The 

 suppression of urine may be so complete that the whole amount se- 

 creted in course of a day may not exceed an ounce or two. Its spe- 

 cific gravity is high. Sometimes, and for a short time, it may be of the 

 color of pure blood ; more usually it is opaque, and of a peculiar dirty 

 reddish-brown hue, and looks as though it really contained dirt. 

 Both urine ancL-sediment have this dirty appearance, which alone, to 

 the eye of an expert, is a tolerably sure sign of acute Bright's disease. 

 There is a very large quantity of albumen in the urine, and, upon the 

 application of heat and nitric acid, the half or even three-quarters of 

 the liquid will coagulate. Upon microscopic examination of the sedi- 

 ment, we find large quantities of epithelium from the tubules and 

 urinary passages, as well as many blood-corpuscles, and casts stud- 

 ded with blood-corpuscles. [Exact observation has taught us that 

 the vascular walls, when inflamed, become permeable to substances 

 which normally would not pass through them. Hence we may pre- 

 sume that it is not the effect of mere pressure upon the Malpighian 

 tufts, but rather of some change in their filtering power which gives 

 rise to the albuminuria in acute Bright's disease.] Dropsical symp- 

 toms set in, and in most cases the dropsy soon becomes very se- 

 vere. The face, hands, legs, and scrotum swell up, and the skin 

 is so tensely swollen that an impression made upon it by the finger 

 is soon effaced. The dropsy of croupous nephritis, like that of pa- 

 renchymatous nephritis, as we shall presently see, shows a great 



