GLANDS. 467 



with the half-developed or young nuclei above described. These aggre- 

 gations of young nuclei are sometimes mingled with the amorphous debris 

 of effete epithelium or with granules and molecules of oleo- albuminous 

 exudation, or of lithate of ammonia, which communicate to them a dark 

 and confused appearance : not unfrequently, also, these masses, when 

 freed from the tubes, retain more or less of their form, and present so 

 exactly the appearance of the casts of the tubuli seen by Franz Simon, 

 and many other observers, in the urine, as to leave no doubt of their 

 identity with these bodies. 



Desquamation of the Epithelium. The changes above described are 

 generally accompanied by an extremely rapid generation of nuclei, which 

 are separated from the basement membrane in an imperfect state, und 

 carried away along with the urine, in which they may be readily detected. 



In some cases of desquamation of the epithelium, it is scarcely possible 

 to recognise any departure from the usual condition of the kidney, either 

 with or without the assistance of the microscope. The degree of vascu- 

 larity is very various in different specimens, and the epithelium thrown 

 off is so quickly resupplied, that there is no very observable change in 

 the microscopic condition of the tubules. In one very intense case, in 

 which ten pounds of very w r atery urine loaded with an epithelial sediment 

 were passed daily for some weeks before death, the kidneys were small, 

 flaccid, and bloodless ; many of the tubes were quite full of nuclei closely 

 heaped together ; some of the nuclei were under-sized ; the cells, when 

 entire, were much compressed and angular. In another instance where 

 urine was passed in large quantity and full of epithelial debris, during 

 the last two months of life, the kidneys were found in an opposite condi- 

 tion, viz. large and congested, and with a firmness and smoothness of 

 section like the first stage of the waxy degeneration formerly described. 

 In this case, the condition of the tubuli was in most parts quite natural ; 

 in some, however, there was extravasated blood, and in others the epi- 

 thelium had accumulated in abnormal quantity. In both these cases 

 there was imperfect development of the epithelium, but cases have 

 occurred to me in which this character was by no means well marked : 

 the crowding of the tubes with nuclei, although frequently found in the 

 earlier stages of desquamation, is not invariably present ; and the tubes 

 were even seen to be gorged with epithelium in a case where none had 

 been separated from the urine for weeks before death. 



So long, therefore, as the epithelium is freely regenerated, the kid- 

 neys may present a tolerably healthy appearance, even on minute 

 examination : after prolonged disease, however, further changes take 

 place ; the epithelium becomes more sparingly generated, and is thrown off 

 in the coherent masses above described, leaving the basement membrane 

 in portions bare, or with a few scattered oval nuclei, much smaller than 

 those cast off, adhering to its inner surface. In the microscopic examin- 

 ation of organs in this condition, there are frequently seen films of such 

 exceeding delicacy and transparency as to be only visible by very care- 



