degeneration of the vessels are frequently associated with it, 

 insomuch that Sir William Gull and Dr. Sutton regard 

 the affection as only symptomatic of a constitutional con- 

 dition characterised by hypertrophy of the walls of the 

 small arteries, due to a fibroid growth in the external coat 

 of the vessels. Dr. George Johnson, on the other hand, 

 regards the hypertrophy as " a consequence of the obstruc- 

 tion which impure blood invariably meets with in the 

 capillaries." Whichever view may be correct, I have 

 certainly seen cases in which the cirrhotic form of kidney 

 disease was associated with cirrhosis of the liver, sclerosis 

 of the blood-vessels, mitral stenosis, and curiously enough, 

 with sclerosis of the posterior 'columns of spinal cord. 

 There is, at least, much in favour of the belief that the so- 

 called "gouty kidney" co-exists with a constitutional con- 

 dition, however imperfectly understood, and that like all 

 other constitutional conditions, it is capable of being trans- 

 mitted, as a predisposition, hereditarily. I have chosen the 

 three forms of Bright's disease as illustrative of my argument 

 because in themselves they constitute the most important of 

 the diseases of the kidney ; but I might readily have in- 

 cluded syphilitic, malignant, and tubercular disease, suppur- 

 ative inflammation, * acute and chronic atrophy, cystic, 

 hydatid, and fatty disease, pyelitis, etc. Those to which I 

 have referred are, however, I trust, sufficient to show that as 

 in every other organ and tissue of the human body, the 

 kidneys are similarly predisposed to disease, and that this 

 predisposition is hereditarily transmissible. 



Renal and vesical calculus similar morbid conditions 

 are undoubtedly hereditary. I could adduce many striking 

 instances of this fact, but the following will suffice : The 

 first case is mentioned by F. Hoffman. The Lady of the 



