GLANDS. 451 



these bodies are liable in the disease under consideration. The vascular 

 tufts may be exposed to injurious pressure from materials accumulated in 

 their capsules. Thus I have seen them flattened into a fourth of their 

 natural compass, while the remaining larger portion of the capsule (pro- 

 bably continuous with an obstructed tubule) has been distended with a 

 colourless and transparent fluid. 



" Such is the minute anatomy of a kidney, which, having suffused from 

 sub-acute inflammation, has undergone, in consequence, no noticeable 

 alteration of volume, although having in its interior a very considerable 

 new development. 



" If the pathology of the uncontracted kidney be rightly understood, 

 that of the contracted specimen will follow it naturally. It seems to me 

 that, in the mere destruction and absorption of tissues, there is abundant 

 explanation of the shrunken dimensions of a kidney which has passed 

 through inflammatory changes. The tubes have burst, and a great 

 portion of their contents has been removed by absorption ; the Mal- 

 pighian bodies have dwindled to a few ; what, then, remains to make 

 bulk ? In the uncontracted specimen a false appearance of size is main- 

 tained by the adventitious cyst-growth, which I have described as filling 

 the interstices of the organ. But the cysts are so much over and above the 

 real kidney-structure ; and if that succulent surplus could be removed, 

 the result, as I have suggested, would be the falling together of wasted 

 textures into a comparatively small compass. The cause of shrinking in 

 the gland is the gradual absorption of spoiled material. This cause 

 operates equally in all chronic cases, and its effects are to be traced in 

 the uncontracted, as in the contracted specimen. The main difference 

 between these two lies in the more or less of interstitial cyst- development ; 

 the most dwindled are those in which least of the new growth has arisen 

 or has survived. 



" I see no reason for believing that the interstitial effusion of lymph 

 effects much towards the final contraction of the kidney. There are not 

 wanting, I know, some pathologists who will assert it to be the great 

 agent in the change ; and who conceive they have seen the whole process 

 of fibre-formation, according to the most approved foreign cell-theories. 

 But I suspect that the observers of new fibre will often have confounded 

 cause and effect. Coincidently with atrophy of the kidney, there occurs 

 a contraction of the reticular matrix ; but that contraction is, probably, 

 consequent on a prior absorption of the intervening tissue. The meshes 

 of the matrix come nearer together, and, in a given space, there is an 

 excess of fibrous tissue, only because the material is withdrawn, which 

 originally expanded that matrix through three times the space it now 

 occupies. 



" Up to the present point, I have studiously avoided introducing the 

 ambiguous and controversial name of ' Bright's disease.' And now it 

 will probably be asked, what relation to Bright's disease is borne by the 

 malady I have treated of. Is it the same thing under another name ? This 



