454 TUBERCULOSIS. 



lous condensation of the bordering connective tissue takes place, 

 may become softened and produce cavities (Eokitansky). 



Lastly, acute miliary tuberculosis of the Mdneys is observed as 

 infiltrations, not exceeding the size of a millet-seed, which, as a 

 rule, are most abundant in the cortical substance, and present, in 

 a comparatively small amount, in the pyramids. Such formations 

 are either scattered or, in part, clustered together, with simulta- 

 neous miliary tuberculosis of the lungs, the peritoneum, and the 

 liver. This form of tuberculosis of the kidneys I have seen but 

 twice. 



Here I wish to draw attention to the nephritis which accom- 

 panies both the tuberculosis of the kidneys and that of other 

 organs. Usually, many different forms of nephritis are classed 

 under the head of " Bright's disease/' and Rokitansky especially 

 distinguishes an acute and a chronic form. I wish briefly to 

 state that, in these two varieties of Rokitansky, I recognize two 

 kinds of inflammation of the kidneys, readily distinguishable 

 as diseases sui generis. What Rokitansky describes as acute 

 "Bright's disease" should be designated croupous nephritis, a 

 characteristic of which, in addition to the inflammatory swelling 

 and redness or hyperaBinia, is a diffused exudation. Rokitansky' s 

 chronic form of " Bright's disease," on the contrary, must be con- 

 sidered an interstitial, catarrhal, or desqiiamative nephritis. 



In croupous nephritis tubular casts appear in the urine, and 

 large quantities of albumen, and the casts are recognizable even 

 after waxy degeneration of the kidneys has ensued. In catarrhal 

 nephritis, on the contrary, there is albumen in the urine in a 

 comparatively small quantity, the tubular casts are missing, and 

 only desquamated epithelia of the urinif erous tubules are found. 

 It is obvious that these forms of inflammation are different only 

 in degree and not in acuteness. Gatarrhal nephritis may also 

 appear in an acute form and be followed by acute recurrences, in 

 which, as a rule, the urine becomes more albuminous. 



The characteristic pathological sign of catarrhal or interstitial 

 nephritis is the striation of the sometimes slightly, sometimes 

 considerably, swelled cortical substance. The striation is most 

 marked on the boundary line between the cortical and pyramidal 

 substances. The seat of the disease is evidently the connective 

 tissue between the urinif erous tubules, while the exudation into 

 the tubules leads only to a desquamation of the epithelia, but not 

 to formations similar to those of croup of mucous membranes. 

 In acute catarrhal nephritis and in its acute recurrences there 



