452 THE SOLIDS. 



question can be answered in a word, only when it shall have been settled 

 what Bright's disease really is. The history of the complaint or com- 

 plaints, included under that title, was, perhaps, originally systematised 

 with too much haste. Starting from dropsy with albuminuria, and noticing 

 that two chief forms of morbid appearance corresponded to that symptom 

 (one, namely, where the kidney was large and mottled ; the other, where 

 it was contracted and knobbed, or irregularly granular), pathologists have 

 considered these two forms as representing the extreme stages of one and 

 the same disease. 



" I must venture to express a doubt as to the justice of this generalisa- 

 tion. After investigating both classes extensively, I am convinced that 

 the mottled and the contracted kidney do, in almost every instance, belong 

 to different morbid actions, not to different stages of the same. 



" The mottled kidneys, in an infinitely large proportion of cases, remain 

 large and mottled to the end. 



" I have now little further to add : with respect to the symptoms of 

 sub-acute inflammation of the kidney, I will make one observation in 

 addition to those already embodied in my paper. The descent of epithe- 

 lium and its germs with the urine ; the presence of albumen there, and 

 sometimes of blood ; the little casts of the tubules, sometimes wrought 

 of fibrin, sometimes of compressed epithelium; these signs belong 

 equally to the sub-acute inflammation and to the scrofulous disease. 

 They are signals simply of renal irritation, whether from one cause or 

 the other, and I suspect they only attend the scrofulous disease at that 

 stage of its progress in which sub-acute inflammatory action is super- 

 added to the primary fatty degeneration. Dr. Johnson's accurate ob- 

 servation has enabled us, under most circumstances, to diagnose the two 

 classes from each other ; for, in the scrofulous disease there will be al- 

 ways seen, as he describes, more or less oil entangled in the fibrin ous 

 casts, or gorging the cells which descend in the urine ; a phenomenon 

 which does not belong to the pure sub-acute inflammation." 



The following pages embrace the more important portions 

 of Dr. Johnson's communication, which is entitled, " On the 

 Inflammatory Diseases of the Kidney." 



" In a paper published in the last volume of the ' Society's Trans- 

 actions,' I gave some account of fatty degeneration of the kidney, and 

 declared my intention to make the inflammatory diseases the subject of a 

 separate communication. On the present occasion, I purpose to bring 

 before the Society the result of some observations on this very interest- 

 ing and important subject. 



" In the paper before alluded to, when referring to the condition of 

 the kidney, which occurs as a consequence of scarlatina, I stated that " it 

 is, in fact, an inflammation of the kidney, excited, like the inflammation 

 of the skin which constitutes the eruption of scarlatina, by the passage 



