were slightly congested. There were old adhesions in the pleuræ and examinapericardium. tion. The aortic and mitral valves were thickened to a trifling degree by old deposit. The liver was large and slightly fatty; there were adhesions connecting it with the diaphragm. The uterus was firmly contracted, about the size of a cocoa-nut, and natural in all respects. The kidneys are accurately represented in the accompanying drawing. They were of about the natural size, but had the appearance of being swollen, looking round and full, one weighing 43 oz. The capsules were adherent and slightly thickened. The surfaces were smooth, and intensely injected; no stellate vessels were visible, but the injection was minute and uniform. On section the pelves were seen to contain a little turbid urine, but were not dilated. The mucous membrane was somewhat injected. The renal substance was intensely injected throughout; the cones a deep purple colour; the cortex of a lighter tint. The latter had nearly lost the faintly linear arrangement proper to it, and had a uniform structure like that of close red-sandstone, but of a brighter red colour. It was harder and denser than natural, and was relatively increased in bulk. A very careful microscopic examination was made. The organ was examined in a fresh state, sections were made of parts hardened by freezing, and subsequently chromic acid preparations were examined. The results were of a somewhat negative character. The epithelium was natural. The tubes were unobstructed as in health, the channels clear and the epithelium in place. There was, however, a general opacity in the sections, the malpighian bodies were fully injected, the fibrous matrix was conspicuous, and the nuclei pervading it were very numerous. This case is brought forward for the sake of the morbid anatomy. Comments. There is unfortunately nothing unusual in the history of the patient. As this condition of kidney is undoubtedly one which leads in the end to granular degeneration, it is a matter of importance to ascertain what is the nature of the change. To this purpose I had long sought an opportunity of examining the kidney in such a case. It appears that the alteration is closely analogous to the state which is set up by disease of the heart. A state of congestion is produced which is of a passive rather than an active kind. The congestion is not associated with any tubal excitement, or inflammation, for these channels remain clear and undisturbed as in health. Such changes as there are relate to the blood vessels and fibrous Post mortem. tissue. There is a general outpouring of fluid from the distended vessels, into the interstices of the organ, which adds to its density, and may eventually become organised into new fibrous tissue, or stimulate the growth of the old. It is known that a fibrinous exudation naturally becomes converted into fibrous tissue. The change in the kidneys, as found after death from puerperal convulsions, seems too small to account for the fatal result. But it is to be considered that it is not the kidney alone which occasions the mischief. The patient may be regarded as one suffering from a certain amount of uræmia-an amount of uræmia probably harmless so long as surrounding circumstances go smoothly-who is suddenly made preternaturally impressible by loss of blood and nervous exhaustion. The susceptibility of the nervous centres to morbid irritants thus suddenly increased, uræmic convulsions result from an apparently inadequate amount of renal disease. The chance of progressive disease resulting is of course increased by frequent recurrence of pregnancy. The following case appears to be an example of granular degeneration gaining ground with successive repetitions of the cause. Amelia Teal, thirty years of age, a native of Germany, came under notice while pregnant for the sixth time. Every pregnancy had been attended with swelling of the legs. She was admitted into St. George's Hospital, under the care of Dr. Bence Jones, in November 1856, with general œdema and albuminous urine. She was at that time in the second month. As the pregnancy advanced the urine became more albuminous. It was at first clear, but afterwards became smoky from the admixture of blood. Casts were found, at first transparent, latterly containing cells of renal epithelium or granular matter. They were always of medium diameter. By April, being then in the seventh month, the albumen had increased so that the coagulum occupied three-fourths of the tube. The urine was diminished in quantity, sp. gr. 1015. It was faintly acid. The œdema had now become considerable in the lower extremities, and the face was puffy and pale. There was constant pain in the loins and frequent vomiting. There was much dyspnoea, so that the patient was obliged to sit upright. Towards the end of the month labour came on, and she sank, apparently from exhaustion, two days afterwards. At the post-mortem examination there was considerable anasarca. The state of the uterine organs was such as is generally found under |