62 DISEASES OF THE PELVIS OF THE KIDNEYS AND URETERS. 



the pyramidal substance ; and, under the microscope, the tubules 

 are seen to be filled with granular, or globular, or lumpy masses, 

 and with the well-known haematoidin crystals. In calcareous in- 

 farction, whitish-yellow stripes are found in the pyramids ; and, 

 under the microscope, black masses are visible in the tubules, which 

 dissolve with effervescence upon the addition of acid. The deposits 

 of triple phosphate, which also produce yellowish-white stripes in 

 the pyramids, sometimes coalesce into stones of the size of a hemp- 

 seed, and may cause suppuration and destruction of the renal pa- 

 renchyma. 



Calculous concretions which form in the pelvis and calyces of 

 the kidney have the same chemical composition as vesical calculi. 

 There is great variety in their size, shape, and number. The smaller 

 ones are no larger than a grain of sand, and are of a rounded form, 

 or else have the shape of a calyx of the organ. The larger ones, 

 which may be of the size of a pigeon's or hen's egg, fill up the 

 whole renal pelvis, often forming a complete cast of its shape, and 

 of that of the calyces. 



SYMPTOMS AND COURSE. Red gritty deposits upon the napkins 

 of newly-born infants, which cease to appear in the course of a few 

 weeks, constitute the sole and not very trustworthy sign of the ex- 

 istence of uric-acid infarction. That of calcareous infarction and 

 the presence of phosphatic deposit in the tubules cannot even be 

 suspected during life. 



In many instances stony concretions in the pelvis of the kidney 

 give rise to no symptoms whatever. We often enough see small 

 urinary calculi, which certainly must have formed in the kidney, 

 voided with the urine, the patient never having suffered the slight- 

 est inconvenience prior to their discharge. In other instances there 

 is renal haemorrhage, and in others the signs of pyelitis calculosa. 

 (See Chapter II.) Some persons experience a sense of weight and 

 of pain in the lumbar region whenever the body is jolted. As 

 these symptoms are very ambiguous, we are not warranted in in- 

 ferring even the probable existence of a renal calculus from them, 

 unless from time to time the pain grow worse, with slight attacks 

 of fever, and unless, after such exacerbations, the urine contain fine 

 granular sediment, or small fibrinous clots incrusted with crystals, 

 and a few blood-corpuscles, or perhaps perfect calculi. 



In two of my cases, the diagnosis of renal calculus was strength- 

 ened by the fact that, on examining some flocculi which swam in 

 otherwise limpid urine, groups of connected epithelial cells, of the 

 characteristic form of epithelium of the pelvis of the kidney, were 

 recognized ; and they showed no signs of fatty metamorphosis, and 



