40 DISEASES OF THE KIDNEY. 



toms, is usually overlooked during life. However, I have sometimes 

 noticed that the formation of a large haemorrhagic infarction in the kid- 

 ney is accompanied by a chill, that the patient complains of severe 

 pain in the kidney affected, and that the urine is scanty and contains 

 blood. When we encounter symptoms like these, in a case of disease 

 of the heart, we may confidently diagnosticate the existence of an in- 

 farction of the kidney, particularly when there is or has been evidence 

 of embolism elsewhere. Renal metastases, which form during septi- 

 caemia, puerperal fever, etc., are usually mere ^accidental" discov- 

 eries upon the dissecting-table. We cannot even suspect their exist- 

 ence during life. 



TREATMENT. As, in most cases of interstitial nephritis, it is im- 

 possible to meet the causal indication when the affection proceeds 

 from the presence of a stone, or from a collection of putrid urine in the 

 pelvis of the kidney, or from embolism or infectious disease, we must 

 confine our efforts to an antiphlogistic treatment, which is much more 

 appropriate in this case than in those heretofore described. The repeat- 

 ed application of leeches, cut cups, and of cold over the kidney, with 

 the subsequent use of long-continued warm baths and warm poul- 

 tices, and the exhibition of drinks containing carbonic acid, are the 

 most approved measures. The sequelae, especially the abscesses and 

 fistulae which may form, must be treated according to the symptoms. 



CHAPTER VI. 



PERINEPHR1TIS. 



ETIOLOGY. In rare instances the adipose tissue, in which the kid- 

 ney is enclosed, becomes the seat of a primary, independent inflamma- 

 tion, which is usually the result of an injury, or, as has been claimed 

 now and then, of exposure to cold. Much more frequently the inflam- 

 mation is secondary to a suppurative action within the pelvis or sub- 

 stance of the kidney. I have seen one case in which a pericystitia 

 extended along the ureter to the fat around the kidney. 



ANATOMICAL APPEARANCES. As a rule, inflammation of the 

 areolar envelope of the kidney soon results in suppuration. The tis- 

 sues then become discolored, and then- meshes are filled with pus. 

 The small collections of pus coalesce and an abscess forms, often of very 

 considerable magnitude, and which may point in almost any direction. 

 In other cases there is no suppuration, but the loose cellular tissue be- 

 3omes condensed and indurated, and is converted into a thick fibrous 

 rind. 



SYMPTOMS AND COURSE. When perinephritis is acute, its symp- 



