262 



REN. 



the irritation produced by certain products 

 developed within the body. I have met with 

 two well marked cases of this kind, in which 

 the characters of the urine, as revealed by a 

 microscopical examination, and the other at- 

 tendant symptoms were the same. In both 

 cases the symptoms were of short duration. 

 When the blood in cases of haematuria is 

 found to be moulded in the urinary tubes, 

 there can of course be no doubt as to the 

 hemorrhage being renal. During the first 

 few hours of an attack of haematuria it com- 

 monly happens that the blood escapes from 

 the kidney before it has coagulated, and at 

 this period of the attack a large quantity of 

 the blood will be found not to have the form 

 of cylindrical moulds when examined by the 

 microscope, but even in this case a careful 

 examination will always detect some moulds, 

 and that will suffice for the diagnosis ; and at 

 a later period of the attack, when the haemor- 

 rhage occurs more slowly it will be found that 

 nearly all the blood has been moulded into 

 the urinary tubes before it has escaped from 

 the kidney. When renal haemorrhage is pro- 

 duced by the irritation of a calculus impacted 

 in the pelvis or the ureter, the blood does not 

 present the fibrinous moulds in question. 



Fatty degeneration of the kidney occurs un- 

 der two distinct forms. In the first form of 

 the disease in question, the kidneys are 

 usually large, smooth, soft, pale, and mottled, 

 and frequently they are scattered over with 

 haemorrhagic spots. On a microscopical exa- 

 mination, there is found to be a great increase 

 in the size and number of the oil globules 

 which exist in small quantities in the epithe- 

 lial cells of the healthy gland. (See fig. 164.) 

 The urinary tubes are filled and distended by 

 the gorged epithelial cells, the dilated tubes 

 compress the capillary plexus on their exterior, 

 and hence, in consequence of passive conges- 

 tion of the Malpighian vessels, the serum of 

 the blood gets mixed with the urine, which 

 thus becomes albuminous ; and when the ob- 

 struction of the circulation is still greater the 

 colouring matter of the blood escapes from 

 the delicate Malpighian vessels and fills the 

 tubes, giving rise to the haemorrhagic spots 

 before mentioned. 



It is only that form of epithelium whose 

 office it is to excrete the solid portion of 

 the urine which becomes gorged with oil ; the 

 delicate epithelium covering the Malpighian 

 vessels, as well as that which lines the straight 

 tubes of the medullary cones, retains its nor- 

 mal condition : the reason of these parts re- 

 maining healthy while the epithelium of the 

 convoluted tubes becomes greatly changed, as 

 well in cases of fatty degeneration of the kid- 

 ney as 'in the desquamative inflammatory 

 diseases before alluded to, will be manifest 

 from a perusal of the second part of this 

 article. 



In this form of simple fatty degeneration 

 of the kidney, all the tubes become almost 

 uniformly distended with oil. In a slight 

 degree, and in the earlier stages, it is often 

 found after death in cases where there is 



no reason to suspect that it has been produc- 

 tive of serious mischief during life : it is not 

 until the fatty degeneration exceeds a certain 

 degree that the functions of the organ become 

 seriously affected. It is this form of fatty 

 degeneration which frequently occurs in ani- 

 mals, as a consequence of their confinement 

 in a dark room, a fact which was first noticed 

 by Mr. Simon.* 



The second form of fatty degeneration of 

 the kidney differs from the first in having 

 combined with it more or less of the changes 

 characteristic of desquamative nephritis. The 

 cortical portion of the kidney is soft and pale, 

 and interspersed with numerous small yellow 

 opaque specks. The kidney is generally en- 

 larged ; sometimes it is even double the natu- 

 ral size. In some cases the cortical portion 

 is somewhat atrophied and granular ; but nei- 

 ther in this nor in the first form of fatty 

 degeneration of the kidney does that extreme 

 wasting with granulation occur, which is so 

 frequent a consequence of chronic nephritis. 

 On a microscopical examination the convo- 

 luted tubes are found filled in different 

 degrees with oil, some tubes being quite free, 

 while others are ruptured by the great accu- 

 mulation in their interior. The opaque yellow 

 spots scattered throughout the cortical por- 

 tion are neither more nor less than convoluted 

 tubes distended, and many of them ruptured 

 by their accumulated fatty contents. The cells 

 which contain the oil are for the most part 

 smaller, more transparent, and less irregular in 

 their outline than the ordinary healthy epithe- 

 lium ; they are increased in number, and many 

 of them are so distended with oil as to appear 

 quite black. In parts of the same kidney 

 there may commonly be seen some of the 

 appearances already described as character- 

 istic of desquamative nephritis. This form of 

 disease is veiy commonly associated with fatty 

 degeneration of the liver, but less frequently 

 so than the first form of fatty degeneration of 

 the kidney. 



The condition of urine connected with this 

 form of renal degeneration is usually as fol- 

 lows : The quantity is small, the sp. gr. 

 rather above' than below the healthy standard; 

 it is generally very albuminous, and sometimes 

 bloody. On a microscopical examination of 

 the sediment which is deposited after stand- 

 ing for a few hours in a conical glass, there 

 may be seen the fibrinous moulds of the 

 tubes so often alluded to, frequently entan- 

 gling blood corpuscles and epithelium. But 

 the main point to be attended to is this, that 

 many of the epithelial cells are more or less 

 distended with oil. (See figs. 149 and 164.) 

 This fatty condition of the epithelium indi- 

 cates with certainty the existence of one of 

 the most serious and intractable diseases to 

 which the kidney is liable. The majority of 

 the cases of acute desquamative nephritis, and 

 many of the chronic cases, end in complete re- 

 covery; but fatty degeneration of the kidney 

 almost invariably leads to general dropsy and 



* Med. Chir. Trans, vol. xxix. 



