LECTURE XVI. 



condary one, whether it sets in as soon as the distur- 

 bance can be perceived, or whether it does not occut 

 until some other perceptible disturbance has gone before. 

 Secondary fatty degeneration, or that in which this 

 peculiar transformation occurs only in the second place, 

 generally succeeds to a first and active stag"; a whole 

 series of those processes which we do not scruple to call 

 inflammations run their course in such a way, that a 

 fatty metamorphosis sets in as the second or third ana- 

 tomical stage of the change. Here therefore the fatty 

 degeneration does not arise as a direct result of the 

 irritation of the part, but where we have the opportu- 

 nity of more accurately tracing the history of the 

 changes, it nearly always turns out, that the stage of 

 fatty degeneration has been preceded by another stage, 

 namely that of cloudy swelling, in which the parts 

 enlarge and increase in extent and density, in conse- 

 quence of their absorbing a large quantity of matter 

 into themselves. 9 Absorbing I say advisedly, because I 

 hold it to be untrue that the part is in any way forced 

 by external influences to take up this matter, or that it 

 is inundated with exudation proceeding from the vessels, 

 for the same phenomena present themselves also in 

 parts which have no vessels. It is only when the ac- 

 cumulation has attained such dimensions, that the 

 natural constitution of the part is thereby endangered, 

 that a fatty disintegration is set up in the interior of 

 the elements. Thus we may designate fatty degenera- 

 tion of the renal epithelium as a stage of Bright's dis- 

 ease (or as I say, parenchymatous nephritis), which has 

 been preceded by a stage of hyperaemia and swelling, 

 in which every epithelial cell accumulated a large 

 quantity of cloudy matter in itself, without there having 

 been originally a trace of a drop of fat observable. 

 Thus we see that a muscle under the influence of 



