GLANDS. 447 



other organs the skin, or the liver ; sometimes will be the mysterious 

 ferment of a fever poison typhus, or scarlatina. In these several cases, 

 whatever variety may exist in the detail of their causation, the essential 

 symptoms during life, and the essential anatomical changes, are strictly 

 identical in kind. They vary only in degree. The materies morbi seeks 

 to affect its discharge by means of an increased activity in the secreting 

 functions of the kidney : it stimulates it ; and the result of the stimula- 

 tion is not so much an increase of the watery secretion as it is an aug- 

 mented cell growth in the tubules of the gland. This acceleration of 

 function is incompatible with maturity of the secreted products; the 

 epithelial cells undergo various arrests or modifications of development, 

 and become more or less palpably imbued with evidences of inflam- 

 mation. 



" If attention happen to be directed to the state of the urine, that 

 fluid will be found to present manifest signs of derangement. Micro- 

 scopical examination will show in it numerous nucleated cells, which, in 

 the hurry of over-secretion, have descended from the urinary tubules. 

 Many free cytoblasts will likewise generally present themselves, together 

 with a variety of those indefinite shapes, which are known to the Mor- 

 phologist as abortions of cell-growth, and which constitute a series of 

 connecting forms between the pus-globule and the healthy gland-cell. 

 Mingled with these, in greater or less quantity, will be noticed also those 

 remarkable fibrinous threads first described by Dr. Franz Simon in con- 

 nection with renal disease. They are seen as exceedingly delicate, almost 

 perfectly .transparent and colourless cylinders, often containing in their 

 mass some of the cell-forms just enumerated, or, not unusually, a few 

 blood discs, resulting from haemorrhage into the tubules. 



" On several occasions, where the renal irritation has been gouty, I 

 have seen crystals of lithic acid thus entangled in fibrin : in other cases, 

 though far less frequently, I have distinguished crystals of oxalate of lime 

 similarly enveloped. It is well known that these little cylinders are 

 fibrinous moulds of the inflamed urinary tubules, some of the other con- 

 tents of which they bring with them in their descent. They are thus 

 quite as characteristic of the disease they attend as croupy expectoration 

 is of tracheitis ; and the cells or crystals included in them often afford the 

 most valuable therapeutical indications. 



" If patients chance to die while their urine is first furnishing the signs 

 enumerated, it will often happen that the kidneys, in their general ap- 

 pearance, present no marked deviation from healthiness. Their cortical 

 substance may, indeed, show the minute blood dots of intra-tubular 

 haemorrhage ; or, more rarely, may present here and there a pin-head 

 abscess. But often, perhaps most often, a superficial observer would pro- 

 nounce the kidneys healthy ; and, unless previous knowledge of the albu- 

 minuria had existed, they would receive no farther attention ; or the Case- 

 Book might contain that vaguest of all vague records * slight con- 

 gestion of the kidney.' 



o o 3 



