THE UEINAEY TEACT. 765 



(3) Suppurative Inflammation of the Kidney. The question as to the origin 

 of pus in abscess of the kidney has engaged the attention of several inves- 

 tigators. In 1852, already, George Johnson observed the transformation of 

 the epithelium into pus, especially in the kidney- tissue, notwithstanding his 

 being a strong humoral pathologist. Lipsky * has produced purulent foci in the 

 kidney experimentally, and asserts that the origin of the pus-corpuscles is to 

 be sought for in the epithelium of the uriniferous tubules, by division and by 

 endogenous cell-proliferation. 



In considering the fact that the interstitial connective tissue, as well as 

 the epithelium, has abundant living matter, it is plain that in nutritive dis- 

 turbances the living matter of the tissue in its entirety must undergo changes, 

 and accordingly take part in the process of inflammatory proliferation. Cohn- 

 heim's idea that in the inflammatory process an active part is to be ascribed 

 exclusively to the colorless blood-corpuscles, must be regarded a failure. 



I have studied the microscopic appearances of suppurative nephritis in the 

 kidney of a man who died with ursemic symptoms caused by hypertrophy of 

 the prostate, which was followed by suppurative cystitis, suppurative pyelitis, 

 and finally, suppurative nephritis. The kidney, especially the cortical sub- 

 stance, had numerous abscesses the size of a millet to that of a hemp-seed. 



At some distance from the yellowish pus-foci, which were just recognizable 

 with the naked eye, the blood-vessels, especially the veins, appeared filled to 

 repletion with blood, dilated, while the capillaries only in part have remained 

 recognizable. Many tufts were enlarged and their vascular loops provided 

 with numerous coarsely granular nuclei. The interstitial tissue was partly in 

 the condition of oadematous swelling, partly sprinkled with groups of yellow- 

 ish, shining lumps. The epithelia appeared in the condition of cloudy swell- 

 ing ; their cement-substance had mostly disappeared, so that many uriniferous 

 tubules were filled with a coarsely granular mass, in which numerous partly 

 homogeneous nuclei were imbedded. Thus, we observe the features of 

 catarrhal nephritis. 



In the neighborhood of many purulent foci the picture of a croupous 

 nephritis is presented, t We find most of the uriniferous tubules filled with a 

 hyaline mass, readily stained with carmine ; the surrounding epithelial layer 

 in the form of lenticular, flattened-in transverse section spindle-shaped, bodies. 

 The nearer we approach the pus-focus, the more the interstitial tissue ap- 

 pears filled with round, shining lumps, at the same time widened and lack- 

 ing blood-vessels. The epithelia of the tubules are converted into irregular, 

 shining lumps, or provided with coarse granules, which show marks of divi- 

 sion, and, by the manner in which they are grouped, indicate their origin from 

 larger lumps. From the homogeneous lumps up to the coarsely granular 

 nuclear products all intermediate stages may be traced, until all the epithelia 

 appear converted into such nuclear formations, which, in part, lie closely 

 together, in part are separated from each other by granular bioplasson. The 

 membrana propria is still recognizable in this stage, and distinctly marks the 

 tubule from the connective tissue, which frequently contains extravasated 

 red blood-corpuscles, beside similar formations. 



Finally, we reach the suppurative focus. (See Fig. 346.) Here the entire 



Wiener Med. Jahrb., 1872. 



t Later observations have demonstrated that tuberculosis of the kidney is invariably 

 accompanied by catarrhal nephritis, while suppuration the production of an abscess is 

 accompanied by croup, us nephritis. El). 



