42 DISEASES OF TllE KIDNEF. 



remains limited ; while, at the same time, the epithelium of the tubules 

 undergoes the changes already described in Chapter IV. The name 

 u parenchymatous nephritis, with amyloid degeneration," is, therefore, 

 more appropriate for this form of disease than the term " amyloid or 

 lardaceous degeneration of the kidney." Even microscopic examina- 

 tion is not by itself sufficient to enable us to distinguish between the 

 affection in question and simple parenchymatous nephritis. But, if a 

 thin slice of the specimen be treated for a few moments with a solution 

 of iodine, the red color of the glomeruli becomes so distinct even to the 

 naked eye, that, even before resorting to the microscope, the appear- 

 ance of a multitude of small red dots, standing out in contrast to the 

 surrounding yellow ground, makes the diagnosis almost certain. Under 

 the microscope the loops of the glomeruli seem remarkably large, and 

 present a peculiar dead lustre. The Malpighian capsules, too, often ex- 

 hibit a broad, homogeneous, dull outline. If, prior to the examination, 

 the preparation have been laid for a time in a dilute solution of iodine, 

 the bodies above described will assume the characteristic yellowish- 

 red color. Upon the subsequent addition of a few drops of sulphuric 

 acid, they become of an indistinct violet or dark blue. It is very un- 

 usual for the tunica propria, and still more so for the epithelium of the 

 urinary tubules, to participate in the amyloid degeneration. 



When an individual, who hitherto has enjoyed good health, is 

 affected by albuminuria, dropsy, and deterioration of the blood, it is 

 so very improbable that he is suffering from amyloid degeneration of 

 the kidney, that that disease may confidently be excluded from the 

 diagnosis. On the other hand, the appearance of similar symptoms in 

 a person who has long been afflicted by syphilis, consumption, tedious 

 suppuration, or any other exhausting malady, makes it extremely prob- 

 able that we have to deal with an amyloid degeneration of the kidney, 

 or, more properly speaking, with a parenchymatous nephritis with 

 amyloid degeneration of the walls of the renal vessels. If the patient 

 also have an enlargement of the liver and spleen, and if the portions 

 of these organs accessible to palpation present the characteristic 

 resistance of amyloid degeneration, the diagnosis is still more sure. 

 In distinguishing between amyloid degeneration and simple parenchy- 

 matous nephritis, Traube lays great stress upon the high specific grav- 

 ity and dark color of the urine in the former disease. My own obsei 

 vations fully confirm the truth of Traube's views, and I may add thai 

 I have been struck, not only by the darkness of the urine, in amyloid 

 renal degeneration, but also by its unnatural, yellowish-brown color ; 

 moreover, my colleague, JZbppe-Seiler, has shown that such urine con- 

 tains extraordinary quantities of indican. There is nothing in the 

 quality of the exudation-casts, or in the degree of frequence of ursemic 



