768 THE UEINAEY TRACT. 



nomenclature, they may be preserved, and certainly are to be preferred to 

 such expressions as " interstitial/' " desquamative," or " parenchymatous " 

 nephritis, which were introduced by Virchow. In nephritis, as in every inflam- 

 mation, the morbid process starts from the vascularized connective tissue, 

 while the participation of the epithelia is only secondary. Every form of 

 nephritis must, therefore, from necessity, be interstitial and parenchymatous 

 at the same time. 



The term " Bright' s disease," I think, ought not to be employed by any 

 scientific person, for it has no significance, and the group of morbid phenom- 

 ena considered under that head include both the primary and secondary 

 changes of the kidney-tissue. 



(1) Chronic Catarrhal Nephritis. We know that in certain forms of nephritis 

 the urine contains no albumen, or very little, which may, however, be tem- 

 porarily increased ; that it contains kidney epithelia detached from the con- 

 voluted and the straight tubules, pus- and blood-corpuscles, and occasionally 

 a hyaline cast, usually from the narrow tubes. The clinical features of the 

 disease are widely different in different individuals. In cases of this kind 

 death may ensue and the kidneys exhibit the appearances described in the 

 preceding article. Should the disease, on the contrary, be prolonged for 

 several months or years, the result of this chronic action is found to be a 

 shrinkage of all the kidney-tissues, and this condition is briefly termed cir- 

 rhosis. Chronic catarrhal nephritis and cirrhosis are therefore identical. 



In the milder forms of this disease the surface of the kidney is irregularly, 

 though slightly retracted. The capsule is in most cases adherent and fol- 

 lows the inequalities of the retractions. The diameters of both the cortical 

 and pyramidal substances are somewhat decreased, and all parts of the kidney 

 show, even to the naked eye, grayish radiating striae. Under the microscope, 

 with low powers the striae prove to be newly formed connective tissue, which 

 is most abundant in the medullary rays of both the cortex and the pyramids, 

 and it is the retraction of this newly formed tissue which causes the irregu- 

 larities of the surface. In the more severe forms of chronic catarrhal nephritis 

 the whole kidney is considerably reduced in size and the inequalities on the 

 surface are very decidedly marked. In transverse section both the cortical 

 and pyramidal substances are seen to be much narrower than in the normal 

 condition. This is more particularly the case in the cortex, of which, in more 

 advanced degrees, only slight remnants are left, and these correspond with 

 the elevations of the surface. It is further observed under the microscope 

 that the newly formed connective tissue is most developed corresponding with 

 the medullary rays, between the straight, narrow tubules, which are reduced 

 in number. Injected specimens of cirrhotic kidneys show plainly a deficiency 

 of blood-vessels in the medullary rays of both the cortex and pyramids. The 

 capillary roticulum around the tufts and tubules is also scanty. The calibers 

 of the capillaries are in many places irregularly distended, and the vasa recta, 

 which are capillary prolongations extending into the pyramidal substance, are 

 narrower than the normal vessels. At the points of transition of cortical 

 capillaries into vasa recta, the difference in their respective calibers is less 

 marked than in the normal kidney. 



The question now arises, What are the changes which take place in the 

 kidney-tissue, producing destruction of tufts, tubules, and blood-vessels, and 

 giving rise to such an extensive new formation of connective tissue in their 

 stead ? 



