come out as black dots, the latter as dark lines, while the intervening structure is comparatively pale.

The outside of the organ was smooth and buff-coloured; it has not been represented.

The kidney was obtained from the body of a India, and had dysentery and abscess of the liver.

soldier who had served in

He had albuminous urine

with dropsy and vomiting, and eventually died in a state of semi-coma. There was extensive hepatization of the lungs.

PLATE IX., to face page 181.
Fig. 1.

Section made by Mr. Lockhart Clarke's process, from a large waxy kidney of which the surface was covered with large curved depressions.

The part represented was opposite to a depression. A large expanse of finely nucleated tissue is seen passing inwards from the capsule, separating the tubes and surrounding the malpighian bodies. The tubes in the neighbourhood contain detached epithelial cells.

At the right-hand side is a part of the new growth, highly magnified, so as to show its fibro-nucleated structure.

Part of a malpighian body appears at one corner; at the other, convoluted tubes. (For comparison, see healthy kidney, Plate V.)

The kidney from which the section was cut was affected in a very characteristic manner. It was obtained from the body of a man who had had an arm amputated for disease of the elbow five years before his death. The immediate cause of death was peritonitis, associated with infiltration of the coats of the duodenum with pus. The liver, like the kidneys, was waxy. No renal symptoms were recognised.

Fig. 2.

A Section of a characteristic Waxy Kidney, made after Mr. Lockhart Clarke's plan.

There is a general increase in the intertubular fibrous tissues. The tubes have lost their epithelial lining, and many contain fibrinous plugs, or casts, in their interior, These casts gave the iodine reaction in a most marked manner, taking exactly the same tint as the malpighian bodies. Another section from the same kidney, which displays the effect described, is represented in the 'Medico-Chirurgical Transactions,' vol. 1. (For comparison, see section of healthy kidney, Plate V.)

The section was cut from the kidney of a man who died of ulceration of the colon.* Latterly he had had some oedema, the urine at the same time becoming unnaturally copious. Owing to the disturbed state of the bowels none could be obtained for examination. At the post-mortem the kidneys were greatly enlarged, anæmic, and of a yellowish white colour, much like that represented in Plate VIII. They gave the iodine reaction, as did the lining of the small bowel. There was a large suppurating cavity occupying the left side of the belly, and connected with the intestinal ulcers.

*The case is published, as an example of ulceration of the colon, in the Pathological Transactions for 1867, p. 102, case of C. Roberts.

PLATE X., to face page 182.

Section of a Depurative or 'Amyloid' Kidney, showing the action of iodine upon the malpighian bodies and small arteries. These are of bright reddish brown, as seen with transmitted light, while the rest of the section has acquired merely a faint yellow colour.

The darker marks upon the section are obstructed tubes. The section was made after freezing with ice and salt.

It was cut from a kidney in a very advanced state of disease, and much contracted, which was obtained from the body of a woman in whom the disease had followed upon severe syphilitic ulceration of the palate, &c.

She had oedema and ascites, the urine being copious and highly albuminous. There was much diarrhoea and vomiting. Latterly pneumonia occurred.

ALBUMINURIA.

CHAPTER I.

INTRODUCTION.

THE OBJECT of this treatise is to describe those diseases which are made known during life by the presence of Albumen in the urine. These have been classed together under the general term Bright's Disease,' or more recently as Albuminuria. Since the publication of The Medical Reports' --the work in which Dr. Bright first described the conditions of kidney associated with his name-pathologists have been busy in building upon the foundation he laid.

With the improved means of research which the microscope has given us, and with a rapidly advancing knowledge of animal chemistry, many refinements have been added to the great discovery of Bright.

tion.

Many and various subdivisions have been made of the Classificaconditions which give rise to dropsy and albuminuria. It would be a weary and unprofitable task to follow pathologists into details of classification, frequently of a highly imaginative character, with which this part of medical literature is burdened. But, while avoiding fanciful distinctions, it will be seen that there are several disorders, different from each other in their cause, their symptoms, and their morbid anatomy, which Dr. Bright associated with albuminous urine.

It is the object of the present volume to remove some of the obscurity and confusion in which the subject has been

B

Structure

Tubes.

Fibrous tissue,

involved, by establishing such demarcations as are suggested by morbid anatomy, and warranted by clinical observation. For the purposes of the physician the kidney may be of kidney. divided into three parts. It consists, first, of a complication of tubes, which, with the malpighian bodies in connection with them, are the sources of its secretion, and are the essential elements of the gland. Secondly, these structures are bound together by a delicate web of fibrous tissue, which, in a section prepared so as to show it, has the appearance of a fine uniform network. This pervades the entire bulk of the organ surrounding and supporting every tube and each malpighian body. Thirdly, the gland is abundantly supplied with blood vessels, which lie with the fibrous tissue between the tubes. Some blood vessels, indeed, of the smallest size, enter into the construction of the malpighian bodies; but with this exception the blood vessels, like the fibrous tissue, are intertubular structures. It is unnecessary to describe with minuteness a structure which will be familiar to every person who is acquainted with the rudiments of physiological anatomy. It is only needful to insist upon the triple constitution of the organ by means of tubes, fibrous tissue, and blood vessels.

and blood

vessels.

POST-MORTEM STATE OF THE HEALTHY KIDNEY.

Since much of what is advanced in the ensuing pages is based upon alterations found after death in one or other of these components of the organ, it is necessary to ascertain first of all what is its normal condition. It is necessary to know what appearances are presented by the tubes, the intertubular fibrous tissue, and the blood vessels, in persons who have died of disorders other than renal. It will be necessary to remove from consideration such changes in the kidney as are of post-mortem origin; and also those variations which depend upon conditions which are common to the whole body, and do not imply any deficiency or peculiarity in the kidneys themselves. The neglect of such precautions has been a fertile source of pathological mistakes.