20 DISEASES OF THE KIDNEY. 



the intertubular tissue by interstitial nephritis. In fact, even the 

 eminent authorities who believe in the distinct nature of the two 

 forms of nephritis, nevertheless admit the possibility of the exist- 

 ence of many intermediate or combination forms between the two. 

 (Cartels.) 



To conclude our description of the pathological anatomy of 

 this affection, it may be well to remark that in many instances the 

 morbid changes which take place in the kidney are by no means 

 easy of recognition by the naked eye. When the inflammation is 

 of moderate extent, we often find merely a few pale-gray streaks 

 lying in the renal tissue, which in all other respects looks perfectly 

 healthy. Sometimes, when the disease is diffuse and scattered, 

 it would be impossible without the aid of the microscope to de- 

 termine with certainty its presence in the tubules and interstitial 

 tissue. The numerous consecutive changes which chronic diffuse 

 nephritis is apt to bring about in other organs and tissues will be 

 duly mentioned when we come to discuss the symptoms of Bright's 

 disease.] 



SYMPTOMS AND COURSE. Pain in the region of the kidney, which 

 has been reckoned by most authors as among the most constant symp- 

 toms of morbus Brightii, according to my observation, is wanting in 

 the majority of cases throughout the entire course of the disease. It 

 is true, that if we press with great force upon the kidney, the patients 

 complain that the procedure is uncomfortable and distressing, but we 

 shall hear a like complaint from well folk, whom we may subject to 

 similar infliction. It is as unusual for the attention of the patient to 

 be called to the grave nature of his disease by any marked diminution 

 in the amount of urine which he passes, as it is for him to suffer pain 

 hi the renal region. After the dropsy and the albuminuria have placed 

 the diagnosis beyond a doubt, most patients, if asked whether they 

 have passed too little urine in the course of their disease, will not only 

 deny it, but will even declare that throughout the entire duration of 

 their dropsy they have made a great deal of water. Such an account 

 as this, from a patient with chronic dropsy, is in itself suggestive of 

 the probable dependence of the dropsy upon chronic renal disease. On 

 the other hand, if a patient assert that his dropsy has developed grad- 

 ually, and that since its commencement he has always passed remark- 

 ably little urine, there is a certain amount of presumption that the 

 dropsy is of cardiac or pulmonary origin, and that it does not proceed 

 from disease of the kidney. However, we must not ignore the fact 

 iJiat such statements from patients, as to their passing an unusual 

 juantity of water, are often the result of a delusion upon their part. An 

 inclination to pass water frequently, a symptom due to sympathy of 



