THE URINE. 811 



absent, at other times present in varying numbers. In chronic 

 catarrhal nephritis and its termination, the cirrhosis of the kid- 

 neys, the patient voids large quantities of a pale, watery urine, in 

 which few or no salts are to be found ; this condition will be more 

 marked the farther the stage of shrinkage has advanced. Albu- 

 men at times is present in small quantities, at times absent. The 

 few kidney epithelia and pus-corpuscles are the only reliable 

 features for diagnosis; sometimes these are accompanied by small 

 shreds of connective tissue. If the kidney epithelia and pus- 

 corpuscles are finely granular and disintegrated to any great 

 extent, the approaching end of life may be foretold. 



Croupous Nephritis. All the features of catarrhal nephritis 

 are present, with the addition of casts. The nature of the casts 

 allows us to decide whether acute or chronic croupous nephritis is 

 present. In both instances the amount of albumen is great, and is 

 found to be still more abundant if blood is mixed with the urine. 

 The amount of albumen, the number of the casts and their sizes, 

 determine the intensity of the inflammatory process. The prog- 

 nosis is more unfavorable in adults than in children. 



If casts characteristic of chronic croupous nephritis are 

 mixed with casts such as we find in acute croupous nephritis, 

 the diagnosis of a chronic inflammation with acute recurrence, 

 i. e.j of subacute croupous nephritis, can be made. The presence 

 of clusters of delicate fat-granules entangled with the albumen 

 (if coagulated by the addition of chromic acid) indicates fatty 

 degeneration of the kidney, the more certainly if fatty casts 

 are also met with. Waxy degeneration can be diagnosticated 

 both from the waxy metamorphosis of the shed-off kidney epi- 

 thelia and the presence of waxy casts. Cases of the recovery 

 of children even from such a disease are on record. In slowly 

 running cases of chronic croupous nephritis the prognosis rests 

 upon the general constitution of the patient, as determined mainly 

 by the condition of the pus-corpuscles. 



Suppurative nephritis exhibits all the features of acute croup- 

 ous nephritis, with the addition of very large quantities of pus- 

 corpuscles. A ruptured abscess of the kidney may be recognized 

 if, besides numerous pus-corpuscles, numbers of kidney epithelia 

 and shreds of connective tissue are also found. The presence of 

 haematoidin crystals would point toward the chronic course of the 

 abscess, which may have existed for some time previous to its 

 evacuation, and w T hich, after bursting, may, for weeks or months, 

 continue discharging pus. 



