LECTURE XVII. 



with anasarca and with dropsy of the different cavities, 

 and may exhibit in the completest manner ail the symp- 

 toms of Bright's disease. They differ however es- 

 sentially from the simply inflammatory form of Bright'a 

 disease, which I designate parenchymatous nephritis, in 

 this respect, that in the latter the disease has not so much 

 its seat in the giomeruli or the arteries, as in the epithe- 

 lium of the kidney, and that the change is often for a 

 long time confined to the epithelium, whilst the giome- 

 ruli themselves may in such cases still appear unchanged 

 when there is scarcely any epithelium remaining in the 

 substance of the cortex. From these forms a third 

 again must be distinguished, where the interstitial tissue 

 is predominantly affected, where thickenings take 

 place around the capsules and uriniferous tubules, con- 

 strictions and contractions are effected, and thereby 

 mechanical obstructions to the current of the blood are 

 produced, which must naturally be attended by secre- 

 tory changes. 



It is very important that you should discriminate 

 between these different varieties which exist in what is 

 apparently a single disease, because you will hence see 

 how it is that the facts which have been ascertained con- 

 cerning the one class cannot forthwith be applied to the 

 other classes, and that neither the same physiological 

 inferences nor the same therapeutical maxims are equally 

 applicable in every one of these several conditions. At 

 the same time, however, it must not be overlooked that 

 these three different forms by no means always appear 



afferent arteries of the cortex, whereby, in the case of a diminished flow of blood 

 through the latter set of vessels, an increased circulation takes place through the 

 former will be found in his Archiv. f. path. Anat. und Pliys. vol. xii., p. 310, and 

 investigations confirmatory of them have recently beeu published by Dr. Beale 

 (Arch, of Med., 1859, No. IV , p. 300. According to those (e. g., Bowman) who 

 make all the arterial blood pass through the glonjeruli, no such collateral rela- 

 tionship could exist between the cortex and medulla. From a MS. Note by the 

 Author. 



