KIDNEYSTHE SPECIFIC GRANULOMATA. 413 



syphilis and other cachexias ; and is associated with similar 

 changes in the liver, spleen, and abdominal lymphatic glands. 

 It is generally accompanied by albumin uria, and in advanced 

 stages by general dropsy. 



At an early stage the kidney may appear perfectly normal 

 to the naked eye. Later, however, it is enlarged, often to 

 twice its normal size, pale, anaemic, and very firm and tough. 

 The capsule can be readily removed, exposing a surface 

 smooth, polished, and glistening. On section, the cortex is 

 thickened and has a peculiar transparent, homogeneous, bacony 

 appearance. 



Microscopically, the changes are found to begin in the walls 

 of the bloodvessels as in other organs, and hence are most 

 readily recognized at an early stage in the Malpighian bodies, 

 which appear, unstained, as prominent, transparent or trans- 

 lucent, polished clumps. The rose color imparted to the 

 amyloid material by the use of methyl violet as a stain, gives 

 the capillaries of the tufts the appearance of being injected. 

 Later the changes are noted in the afferent and efferent vessels 

 of the tufts, and arterise recta?. Not infrequently the base- 

 ment-membrane of the uriniferous tubules may be similarly 

 affected the lining epithelium being in various stages of 

 granular and fatty degeneration. This degenerative change 

 is often associated with parenchymatous and interstitial ne- 

 phritis. 



THE SPECIFIC GRANULOMATA. 



Syphilis in its early stages may give rise to a nephritis 

 similar to that produced by other infectious diseases. In its 

 later stages it is a very frequent cause of amyloid degenera- 

 tion, and may also produce a chronic interstitial nephritis. 

 Syphilitic gummata of the kidneys are very rare. 



Tuberculosis occurs as a part of an acute miliary or chronic 

 general tuberculosis, though cases are seen in which the disease 

 starts primarily in the kidneys ; infection may take place 

 also along the ureters, secondarily to tuberculosis of the tes- 

 ticles, seminal vesicles, and bladder. The disease is generally 

 more marked in one kidney than in the other, or may be 

 entirely confined to one. In primary tuberculosis of the 

 kidneys, at an early stage, the tubercular foci small yellow 



