Contracted Kidney 347 



into a small cicatricial mass. The fibrous capsule is so firmly incorpo- 

 rated with the thickened trabeculas of the interior of the gland that at 

 the post-mortem examination it cannot be stripped off. 



In the early clays of cirrhosis the new fibrous element of the kidney 

 is soft and vascular, but its subsequent contraction is only a matter of 

 time ; and during its progress, by pulling irregularly upon different 

 parts of the kidney, it throws the histological arrangement into com- 

 plete disorder, and, obliterating certain tubes, causes retention of their 

 secretion and a wide-spread cystic degeneration. 



Renal dropsy. When the kidneys are or have been inflamed, 

 their function, which is the excretion of urine, is necessarily impaired, 

 and the vessels generally, and the capillaries in particular, are over- 

 full. But from over-filled capillaries a certain amount of exudation is 

 sure to occur, and the result is that in renal disease serous transuda- 

 tion takes place into the lymph-spaces and into the connective tissues 

 generally. Thus, the eyelids and scrotum swell, the feet and ankles 

 become ' puffy,' and the legs pit on pressure ; the lungs become water- 

 logged, and dropsical effusions fill the pleura, pericardium, or peri- 

 toneum. Pulmonary oedema is a very common and serious complica- 

 tion of kidney disease ; so also is cerebral anasarca. 



Because the feet are the lowest parts as the man walks or stands, the 

 uxlema first appears there. After the night's rest in bed the feet may 

 resume their normal size, the fluid being absorbed and deposited, 

 perhaps, in the face, which then becomes * bloated.' But, after the 

 patient has been up and about, the face improves again and the feet 

 in turn are enlarged. The serum actually trickles down through the 

 loose tissue, so that, as Watson remarks, a tight waistband may pre- 

 vent the descent of the fluid and keep the upper part of the body alone 

 oedematous, whilst if the patient lies constantly on one side that side 

 only is infiltrated. Dropsy of the submucous tissue of the air- 

 passagcs is frequently a cause of death. 



Krec purgation is often useful in the case of dropsy, as it diminishes 

 the amount of fluid in the vessels and so encourages them to soak up 

 and utilise the extravasated serum. 



l)io|)sy from liver-disease appears first as abdominal ascites, 

 whilst that from heart disease generally begins as anasarca in the legs. 

 It is quite impossible to draw a hard-and-fast line, however, between 

 these conditions. Indeed, kidney disease and heart disease often go 

 hand in hand, as it were ; for valvular disease of the heart begets 

 venous congestion of the kidney, which is a common cause of nephritis. 

 Thus the kidneys^being diseased, cannot work properly, so that impure 

 blood is being circulated, and the capillaries throughout the body 

 struggle to resist its passage through them, their muscular and fibrous 

 walls becoming thickened. To overcome this resistance the left 

 ventricle works with extra energy, and its walls increase in strength in 

 consequence, just as a blacksmith's biceps grows by exercise. As a 



