GLANDS* 459 



it is not until the fatty accumulation has attained a certain amount, 

 that the functions of the kidney are interfered with. It is this form 

 of fatty degeneration of the kidney which occurs in animals, as a con- 

 sequence of confinement in a dark room. In the human subject, al- 

 though in the earlier stages it is a very common occurrence, yet in the 

 more advanced stages it occurs less frequently than the second form 

 of fatty degeneration. This form of the disease is represented in the 

 5th figure of Dr. Bright's 3d plate, as well as in the 1st, 2d, 5th, and 

 6th figures of Rayer's 8th plate. The cortical portion of the kidney, to 

 use the words of Dr. Bright, is soft and pale, and interspersed with 

 numerous small yellow opaque specks. The kidney is generally en- 

 larged ; sometimes it is even double the natural size. In some cases, the 

 cortical portion is somewhat atrophied and granular; but neither in 

 this, nor in the first form of fatty degeneration of the kidney, does that 

 extreme wasting with granulation occur, which is so frequent a conse- 

 quence of chronic nephritis. 



" On a microscopical examination, the convoluted tubes are found 

 filled in different degrees with oil ; some tubes being quite free, while 

 others are ruptured by the great accumulation in their interior. The 

 opaque yellow spots scattered throughout the kidney, are neither more 

 nor less than convoluted tubes distended, and many of them ruptured 

 by their accumulated fatty contents ; just as the red spots are found to 

 be convoluted tubes filled with blood. The cells which contain the oil 

 are for the most smaller, more transparent, and less irregular in their 

 outline than the ordinary healthy epithelium; they are increased in 

 number, and many of them are so distended with oil as to appear quite 

 black. In parts of the same kidney, there may commonly be seen some 

 of the appearances already described as indicative of desquamative 

 nephritis. This form of disease is very commonly combined with fatty 

 degeneration of the liver ; but less frequently than is the first form of 

 fatty degeneration of the kidney. 



" The peculiarities of the second form of fatty degeneration of the 

 kidney result from a nephritic condition of the organ, dependant on the 

 presence of some irritating material in the blood being associated with a 

 tendency to fatty degeneration ; this tendency resulting from the pre- 

 sence in the blood of mal-assimilated fatty matter. The nephritic con- 

 dition is manifest by an increase in the number of epithelial cells ; the 

 tendency to fatty degeneration, by a filling of many of these with oil. 

 Although the two conditions are combined in this and in similar cases, it 

 must be remembered that they are essentially distinct in their nature and 

 origin. Each cell which escapes from the kidney carries with it a por- 

 tion of the morbid material. The oil is in the form of visible globules ; 

 while the cells which contain no oil doubtless contain some other 

 material which is invisible, or less readily seen than the oil globules. 



" I have now distinguished and described four conditions of the 

 kidney : 



P P 



