772 THE URINARY TRACT. 



the existing chronic affection. In persons dead of chronic croupous nephritis 

 of long standing, the kidney is found to have an entirely different appearance 

 from the cirrhotic kidney. It is more frequently enlarged than diminished in 

 size. The surface is often nodulated, and between the nodules are seen deep 

 cicatricial retractions. These retractions are never found uniformly over the 

 surface. The capsule is adherent to the retractions. In transverse sections 

 of a kidney of this kind we find that the cortical substance is absent in those 

 parts corresponding with the retractions of the surface, while in other places 

 the cortex may be unaltered, or even increased in bulk. The pyramidal sub- 

 stance may be unchanged, or it may be diminished. In contradistinction to 

 the more or less uniform shrinkage of the kidney called cirrhotic the par- 

 tial destruction of the tissue which occurs in chronic croupous nephritis 

 might be designated atrophy ; for, under the microscope, we find in the most 

 diseased portions only traces of the original kidney structure. 



Cysts are found to be larger and more numerous in kidneys affected with 

 chronic croupous nephritis than in those which are contracted and reduced by 

 cirrhosis. Both fatty and waxy degeneration are met with in cirrhotic as well 

 as in atrophied kidneys, but these changes are more extensive in the latter 

 than in the former. In the so-called " large, white kidney" the highest 

 degrees of fatty degeneration occur as a secondary result of chronic croupous 

 nephritis. The "lardaeeous" change is also a secondary condition of this 

 form of nephritis. 



In sections of the depressed cicatricial portions of the cortical substance 

 of kidneys in chronic croupous nephritis, we find a large amount of connective 

 tissue, which may be either homogeneous or fibrous, and which has only a 

 scanty supply of blood-vessels. In the cirrhotic kidney the newly formed 

 connective tissue is more or less regularly distributed throughout the kidney 

 structure. The uriniferous tubules are in part transformed into connective 

 tissue, while still retaining the outlines of their original configuration. In 

 atrophy of kidney, on the contrary, there is no regularity in the arrangement 

 of the connective tissue, and we find only remnants of the former tubules. 

 We further observe in these latter cases irregularly scattered sections of 

 tubules, from which the epithelial lining has entirely disappeared. Other 

 tubules, still recognizable by their shape, are crowded with inflammatory 

 bodies, which have evidently arisen from the tubular epithelia in the forma- 

 tive stage of connective tissue. The connective tissue, more particularly in 

 the subacute forms of croupous nephritis, is often observed to be filled with 

 inflammatory corpuscles ; and in the midst of groups of these bodies of the 

 ordinary color, and readily taking the carmine stain, we also find aggregations 

 of corpuscles, light brown in color, and unaffected by the carmine. I am 

 inclined to regard these formations as the offspring of the former epithelia of 

 the tubules. (See Fig. 350.) 



Not infrequently, in the middle of these brownish clusters, hyaline casts 

 may be found ; these probably originated in the convoluted tubules of the 

 first order, and were too large to be carried through the narrow tubules. 

 What the ultimate fate of these casts may be, we can only surmise. The 

 tufts, as in cirrhosis, are reduced to a mass of medullary corpuscles, and a 

 similar change takes place in the surrounding capsule. These facts lead to 

 the conclusion that a destruction of the epithelial and vascular structures 

 takes place, with the final result of a new formation of connective tissue. 



In the highest degrees of chronic croupous nephritis, in addition to the 



