THE URINARY TEACT. 753 



of intensity. Sometimes it appears in a mild form, not seriously 

 interfering with the general health of the person, while in other in- 

 stances it destroys life in a very short time. The presence of casts 

 in the urine I consider a serious symptom, though, if present only 

 in small numbers, they indicate a slight inflammatory disturbance 

 in the kidneys, which might run for quite a number of years. 



As the urinif erous tubules are lined with only a single layer 

 of epithelia, a perfect recovery from any attack of nephritis must 

 depend upon the reproduction of the lost epithelia from those 

 which remain. Nothing is known concerning the reproductive 

 power of kidney epithelia, and that it occurs is a mere inference. 

 Patients overcome milder attacks of catarrhal nephritis ; but the 

 danger rests in repeated recurrences, of this nephritis, which at 

 length leads to cirrhosis of the kidneys. Recovery after croupous 

 nephritis seems in children to be complete f . i., after scarlet 

 fever or diphtheria. They sometimes overcome acute haemorrhagic 

 croupous nephritis of a degree which invariably kills the adult. 

 Recovery, furthermore, is often observed after the nephritis of 

 pregnancy, probably for the reason that only the right kidney is 

 the seat of disease. Nephritis produced by certain poisonous 

 drugs (cantharides, turpentine, etc., often, also, iodine and arsen- 

 ical preparations) may terminate in a cure as soon as the admin- 

 istration of the poison is stopped. Even chronic nephritis, with 

 waxy degeneration, will, if caused by chronic pyaemia, subside 

 after the removal of the source of suppuration. In such cases of 

 recovery certain regions of the original kidney-tissue are de- 

 stroyed, and replaced by cicatricial connective tissue, produc- 

 ing a condition of atrophy in those portions, while the greater 

 part is left unchanged. In most instances of spontaneous croup- 

 ous nephritis, however, the disease becomes chronic, with re- 

 peated attacks of intercurrent acute nephritis, and terminates 

 finally in a partial atrophy of the kidney-tissue, or a general 

 hypertrophy of the interstitial connective tissue. Such kidneys 

 are usually subject to cystic, fatty, and waxy degeneration. 

 Whether or not the two last-named conditions arise primarily, 

 without any preceding inflammation, I am unable to say. 



ACUTE INFLAMMATION OF THE KIDNEYS. BY ALFRED MEYER, NEW- YORK.* 



Since Richard Bright, in 1827, drew attention to certain diseases of the 

 kidneys, in consequence of which severe disturbances of the organism, and 



* Abstract of the essay, " Untersuchungen iiber acute Niereuentziindung." Sitzungsber. 

 d. Kais. Akademie d. Wissenscli. in Wien, LXXV. Bd., 1877. Translated by the author. 



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