GLANDS.. 443 



the interesting and important conclusion, that the oily dis- 

 ease of the kidney is generally co-existent with a similar affec- 

 tion of the liver, and even with steatomatous deposition in 

 the coats of the arteries, and to a less extent with tubercular 

 deposit in the lungs. 



Dr. Johnson also maintains the opinion, that the oily de- 

 position is not preceded by any inflammatory or congestive 

 stage : congestion accompanies the disease ; but this may be 

 either active or passive, and when the latter, is produced by 

 the pressure to which the vessels are subject in consequence 

 of the distention of the epithelial cells, and which pressure 

 gives rise to the effusion of serum and blood within the tubes. 

 These results are, however, the effects, and not the cause of 

 the disease. 



The dropsy ensuing on scarlet fever, Dr. Johnson con- 

 siders, does not depend upon the presence of oil in the cells 

 of the kidney ; this dropsy, he regards as the result partly of 

 the cutaneous disease, and partly of the effort made by the 

 kidneys to relieve the skin, the circulation and functions of 

 which are so much impaired. 



From experiments made on cats, it appears that confine- 

 ment in dark chambers has the effect of inducing granular dis- 

 ease of the kidney, accompanied by deposition of oil in the urine. 



Dr. Johnson regards the existence of albuminous urine as 

 quite a secondary effect. 



The results of Mr. Toynbee's investigation on the pathology 

 of Bright's disease are very different, as we shall presently 

 perceive, from those of Dr. Johnson: both observers, however, 

 agree in the statement that there can be no doubt that albu- 

 minous urine often exists, without any deposition of fat in the 

 epithelial cells of the kidney ; as in dropsy after scarlatina. 



The following is Mr. Toynbee's own exposition of his re- 

 searches on the pathology of Bright's Disease : 



" The First Stage of the Disease. In this stage the kidney is enlarged, 

 and innumerable black points are visible, which are the corpora Malpi- 

 ghiana dilated, and their vessels distended with blood, seen through the 

 capsule. The white spots which derive their appearance from the col- 

 lection of fatty matter, begin to be perceptible. 



O O 



