GLAN>S. 469 



the kidney lias become extremely contracted and irregular, they often 

 in part disappear. 



" The atrophied portions of the kidney are usually exsanguine, and 

 of a tawney or drab colour : they have considerable hardness and 

 toughness. Examined microscopically, they appear to consist of fibres 

 and fusiform cells in great abundance, and more or less granular exuda- 

 tion, according to circumstances. According to Henle, Eichholtz, Gluge, 

 and others, these fibres are in great part new formations ; Johnson and 

 Simon consider them as nothing more than the compressed parenchyma 

 of the gland, from which all the other normal elements have disap- 

 peared. I look upon them as formed in great part by the breaking 

 up of the basement membrane of the tubes (as above described), as well 

 as from the parenchyma and obliterated capillaries. It is not im- 

 probable, however, that, in addition to these elements, some new fibrous 

 tissue is formed. 



" The extreme stage of the atrophied kidney is nearly the same, 

 whether exudation have existed or not. 



*' Microscopic Cyst-formation. It occasionally happens, on examining 

 the section of a kidney with the microscope, that we see scattered through 

 some parts of the section a few small clear vesicles, of nearly circular or 

 oval form : they are either of a very pale straw colour, or nearly colour- 

 less, and are perfectly clear and translucent, with a very distinct sha- 

 dowed margin, which causes them to stand out in bold relief from the 

 other textures composing the section. Their diameter is usually from 

 ^th to -^th of a millimetre, but in this respect they vary considerably ; 

 sometimes they appear to lie in the tubular areolae, and at other times to 

 be unconnected with these. Very rarely they have appeared to contain 

 a few granules ; most commonly, even when there is granular exudation 

 around them on every side, they contain nothing but clear fluid. Their 

 refractive power is not so great as that of oil, while it is much greater 

 than that of the spherical cells of the tubes : hence their distinct and 

 characteristic shadowed outline. 



" These bodies (which, however, have never appeared to me to present 

 distinct nuclei) are probably the same with the " nucleated cells or 

 vesicles" described by Mr. Simon as resulting from the extravasation 

 of the epithelial cells into the intertubular tissue, and as progressively 

 enlarging, so as to form the cysts visible to the naked eye, which are so 

 common in diseased kidneys. To these structures he attaches great 

 importance in the pathology of the kidney, conceiving them to be the 

 invariable result of the desquamative disease when of long standing ; 

 the kidney being, in Mr. Simon's opinion, changed more or less into an 

 aggregation of microscopic cysts, which either undergo absorption and 

 lead to atrophy of the organ, or increase in size and monopolise its 

 texture. Thus, according to Mr. Simon, the serous cysts so common in 

 the kidney result from an enormous development and hypertrophy of 

 extravasated epithelium cells, which assume the character of the vesicles 



