cancer in 5. In 30 of the number there was no trace of either syphilis, tubercle, or malignant disease.* KIDNEYS DESCRIBED IN DETAIL. To this sketch of the general pathology of the depurative disease it will be necessary to add some particulars regarding the kidneys. disease. These organs are exceedingly favourite seats for the deposit. A favourite The malpighian tuft, in its arterial character and its minute seat of the subdivision, possesses in the greatest degree the facilities for the peculiar deposition. The kidneys are often attacked first; and even when this is not the case, they usually become so early involved in the disease that the change in their secretion is one of the first symptoms. The following changes are produced in their appearance Naked eye and structure. appear ances. Examined at the earliest date at which the change can be Earliest recognised, the kidney is slightly pale and anæmic. If changes. altered in consistence, it is firmer than before. The organ would pass for natural, but that the iodine solution dots the malpighian bodies. The surface is smooth, rather pale perhaps, the cortex in due proportion, and every other character that of health. As the disease goes on, an increase of size takes place, and the capsule becomes adherent. At this Anæmia. * In the preceding account of the waxy or depurative infiltration I have rather endeavoured to show what it is than what it is not. In the face of the direct evidence which has been brought forward it has not been thought necessary to discuss the starch theory at any length. It may be as well to allude to an opinion, originally promulgated by Meckel, that the deposit consists essentially of cholesterine. This substance is not nitrogenous, as the amyloid deposit is known to be. It does not give the characteristic reaction with iodine. It has, as far as I am aware, only been found in the liver as connected with this change; in which organ cholesterine occurs in many forms of disease. This substance probably is rather an occasional and accidental associate of the waxy deposition than essential to it. The waxy change is continually associated with fatty degeneration, and in the liver cholesterine-which is allied to fatis sometimes present. For an interesting account of the opinions which have prevailed regarding this disease I may refer to a paper by Dr. Pavy 'On the so-called Amyloid Degeneration,' in the Guy's Hospital Reports 1864. N Increase of time the cortex is firm, pale, and increased in thickness. bulk. It varies in texture. When the increase of size is great, there is usually more or less fatty change in the epithelium, and the cortex is of a pale fawn-colour, and opaque, like a parsnep. Under these circumstances the kidneys often weigh 10 or 11 oz. each. The largest that have come under my notice weighed, the two together, 33 oz. In other cases, where Change of there is no fatty tendency, and the increase of size is less, the cortex often has a pinkish or grey translucency, as if a transparent material were interspersed throughout its structure. This transparent appearance is most observable near the capsule. When the grey effusion is abundant, it gives a peculiar firmness and elasticity to the organ. Sometimes the two conditions exist together, buff specks or lines being separated by grey waxy matter. texture. Superficial depressions. Effusion between the tubes. Finally causing Contractions. The capsule is now adherent, and probably thickened. The surface, still smooth, or marked only by a few curved depressions, has lost the uniform vascularity of the healthy kidney, and has a general bloodless appearance, only variegated by irregular red blotches, or a few stellate vessels. This condition of enlargement belongs to the earlier periods of the disease. The effusion is intertubular, and has the same. contractile tendency as the intertubular effusion in granular degeneration. The new material between the tubes, which is very plentiful, has a regular process of condensation and contraction to go through. It is most abundant near the capsule, and its contraction is early indicated by depressions on the surface--small curved depressions, few and partial. According to the duration of the disease, and the rate at which the contracting process goes on, the appearance and bulk of the organ vary. The surface may present various forms of unevenness; sometimes covered with large smooth elevations, giving an undulating outline; sometimes irregularly deformed in some places, elsewhere smooth. Sometimes, and this in the most advanced cases, where there is much loss of bulk, the organ has obviously shrunk out of shape; it has lost more in width and thickness than in length, and has a lean and attenuated look; and when the capsule is taken |