448 THE SOLIDS. 



" On minuter analysis, however, the microscope will reveal a large 

 amount of disease. The ultimate tubules are found, as one might antici- 

 pate, gorged with an uneliminable excess of crude and vitiated secretion. 

 Blood and amorphous matter, and an infinite range of cell-growth, from 

 pus globules to the healthy germination of the gland, present themselves 

 in various combinations ; and among them shape or colour will sometimes 

 enable us to discern the specific cause of the derangement crystals of 

 lithic acid or of oxalate of lime, or the ochreous tinting of bile. By pro- 

 ducts such as these the tubes are plugged, irregularly distended, and 

 not unfrequently burst and annihilated. So close is the compaction of 

 material, even in many of those tubes, that have no shaped inflammatory 

 products within them, that they are plainly impervious ; and it is only 

 by artificial means, by further tearing of the fragment, or by use of 

 chemical agents, that we can satisfy ourselves that the dense plug in 

 question consists but of agglomerated gland-cells. 



" Now in the post mortem examination of these chronic cases, we may 

 or 'may not find the kidneys materially contracted and deformed. It 

 happens, to say the least, very frequently that the organ has preserved 

 its full size and presents the ordinary colours. Perhaps it may have a 

 cyst or two on its surface. Between such kidneys, and those which are 

 all knobbed and puckered and wrinkled, there is not the essential differ- 

 ence which first sight would suggest. I shall first detail the changes 

 which are latent in the healthier-looking kidney, and subsequently shall 

 consider the anatomy of the contracted specimens, and analyse the cir- 

 cumstances which determine that apparent atrophy of the gland. 



" In the first instance, then ; In commencing the microscopical exami- 

 nation of the cortical substance, we partially find a similar state of tubes 

 to that described in connection with the sub-acute attack a state, 

 namely, of unequal distention and of blocking up by their own accumu- 

 lated products. In the cases which have lasted a long time, these pro- 

 ducts will often be found to have undergone material alterations, from 

 the combined effects of pressure and absorption. The contents of the 

 epithelial cells will have lost much of their natural fine granularity ; so 

 that the cells will appear, even when viewed singly, to have acquired a 

 marked increase of solidity and substance. But, more than this in 

 many parts hardly a trace of tubularity will be found ; the tubes have 

 been burst ; their contents have been interfused amid the matrix and 

 blood vessels ; and their debris may be found on opposite sides of a pre- 

 paration, here black and bloated, there pale and collapsed. 



" Betwixt these trophies of disease there is a new manifestation. The 

 interspace is crowded with a profuse development of cysts, apparently 

 foreign to the healthy structure of the part. They are of all sizes ; some 

 are visible to the naked eye ; some are of the magnitude of normal gland- 

 cells, Tg/w) 1000 ' kufc ^ e ma J OI> ity are f an intermediate bulk, 



