454 THE SOLIDS. 



they have become washed out by the current of fluid poured into the 

 tubes from the Malpighian bodies : many of the cells entangled in these 

 casts have, consequently, become disintegrated and broken up into amor- 

 phous granular masses ; thus presenting appearances which I shall pre- 

 sently show are characteristic of the casts occurring in cases of chronic 

 nephritis. Such is the morbid anatomy of the kidney, and such are the 

 characters of the urine occurring as a consequence of scarlatina. 



" To the form of renal disease here described as occurring in connection 

 with scarlatina, I propose to give the name of ' acute desquamative 

 nephritis? 



" The next form of inflammatory disease, to which I would direct at- 

 tention, is one of great interest and importance. Two drawings by 

 Mr. Westmacott represent the disease in two different stages : one re- 

 presents a kidney in the earlier stage ; the other shows a more advanced 

 stage of the same disease. The kidney is never much enlarged ; in the 

 earlier stage, the size of the organ is natural, and the structure of the 

 cortical portion appears confused, as if from the admixture of some 

 abnormal product : there is also some increase of vascularity. As the 

 disease advances, the cortical portion gradually wastes ; the entire organ 

 becomes contracted, firm, and granular ; the pyramidal bodies remaining 

 comparatively unaffected even in the most advanced stages : simultaneously 

 with the diminution in size of the kidney, there is a decrease of vascu- 

 larity. These changes occur very gradually : the disease is essentially 

 chronic, having a duration in most cases of many months, and in some 

 even of several years. It is almost confined to persons who are in the 

 habit of partaking freely of fermented liquors ; it is very commonly seen 

 in those who have suffered from gout, and is not uncommon in those 

 who, having indulged freely in the use of fermented liquors, have yet 

 never had an attack of gout. It is sometimes, but I believe rarely, 

 met with in those whose mode of life has been strictly temperate and 

 abstemious. The symptoms usually attending the disease, are the fol- 

 lowing : dropsy, which commonly is not excessive, often coming on 

 only in the most advanced stages, and sometimes being entirely absent 

 throughout the entire progress of the disease. The urine is commonly 

 albuminous: it seldom, however, contains a very large quantity of 

 albumen, and sometimes there is no coagulation on the addition of heat 

 or nitric acid. The urine is sometimes high-coloured and scanty ; but 

 in most cases, it is rather abundant, pale, and of low specific gravity 

 from 1005 to 1010. In some instances, the quantity of urine is much 

 greater than in health, and this increased quantity of urine is secreted by 

 kidneys which are found after death to be contracted to one-third of 

 their original bulk. In urine of such low specific gravity, there is, of 

 course, a deficiency of the solid constituents, while the blood, which is 

 much changed and impoverished, contains an excess of these materials. 



" On a microscopical examination of the kidney, the nature of the above- 

 mentioned changes is very clearly revealed, and, at the same time, the 



