CONGESTION OF THE KIDNEYS. 



357 



grotzky has observed a fatal subacute nephritis as a complication 

 of bronchitis ; Rivolta has described a case of subacute bacillary 

 nephritis. (Concerning glanderous or tuberculous nephritis, see 

 Glanders and Tuberculosis.) 



This pathology is also that of toxic nephritis (metallic and 

 organic poisons), which are ordinarily produced by the internal 

 use or a too extended application of cantharides, essence of turpen- 

 tine, croton oil, squill, etc. Numerous clinical facts coming within 

 this group have been described under the name of "hematuria" of 

 the ox. The following agents also possess an inflammatory action 

 upon the kidneys : tar, carbolic acid, iodoform, phosphorus, arsenic, 

 lead, mercury, etc. ; also moulds, rust, fungi, charbon ; certain in- 

 sects, such as snails, cabbage-lice (Neubert); raw potatoes ingested 

 to excess (Schick), and certain varieties of cotton-seed flour. 



Secondary nephritis may occur by propagation of the inflamma- 

 tion in cystitis or pyelitis, etc. We must also specially mention 

 nephritis produced by hemoglobin infarctus, which appears in the 

 course of hemoglobinemia ("black urine'') of the horse. Formerly 

 it was wrongly considered as the primary aflection. 



Pathological anatomy. The macroscopic alterations vary with 

 the anatomical form of the disease. Sometimes one kidney only 

 is diseased, at other times both are aflected. The augmentation of 

 volume may reach double or treble the normal dimensions. The 

 renal tissue is soft, sometimes as if reduced to pulp (inflammatory 

 oedema, hemoglobin infarctus) ; its tint is yellowish, marked with 

 red spots, or with a uniform difl'use red ; hemorrhagic infiltrations 

 may be observed in it. When the substance of the kidney under- 

 goes fatty degeneration it is pale gray or even whitish ; these ab- 

 normal colorations coexist at times and give the organ a particular 

 marbled aspect. On section, a thick creamy liquid often runs out ; 

 the glomeruli are very prominent ; the renal capsule may ordinarily 

 be detached with the greatest ease. In the pelvis we find a thick 

 urine, gelatinous or bloody. There are cases (nephritis of the 

 glomeruli, circumscribed nephritis) where the surface of the kidney 

 does not show anything abnormal. 



The microscopic alterations differ considerably according to the 

 location of the process. In human medicine we distinguish the 

 following anatomical forms : 



1. Acute nephritis of the glomeruli. The epithelium of the glo- 

 meruli and of the capsules is tumefied, desquamated ; the capsules 



