fortnight later the belly, and then the face and legs, began to swell. The bowels were loose. When seen he was puffy and pale, with elastic swelling of the limbs, which did not 'pit,' a very usual state of things with children. The belly was swollen and fluctuated; the urine smoky and intensely albuminous. He was ordered half a drachm of the infusion of digitalis, with two minims of tincture of sesquichloride of iron, three times a day, and to drink in the course of the day two pints of spring water beside his ordinary fluids. When seen on the 23rd, he was no better, the urine had not increased, and on enquiry it was found that he had not drunk all the water. The digitalis and the tincture of iron were doubled in quantity; he was ordered to be strictly confined to liquid food, and the water was enforced. At the next visit, on the 26th, all œdema had gone, though the belly still contained fluid. The urine was still bloody, but was much less albuminous. The same system of treatment was persisted in. On January 19 all dropsy had disappeared; the urine contained no blood and only a trace of albumen. Under the action of sesquichloride of iron this rapidly disappeared; the child returned gradually to his ordinary way of living, and was dismissed in perfect health. Neither oedema nor any trace of albumen could be discovered after January 9. The case illustrates the treatment of the uncomplicated disorder. Scarlatinal Dropsy, with convulsive attacks. Recovery. George Taylor, three years of age, had an attack of scarlet fever which was followed by swelling of the face, legs, scrotum, and belly. Diarrhoea came on and the swelling subsided. The bowels remained loose after the swelling had entirely disappeared. He was then attacked by vomiting, which was frequent through the whole of one night, and in the morning three well-marked epileptiform fits occurred in succession. Between the fits, and subsequently, he was drowsy. He was now brought to the Children's Hospital, and became my patient. He was extremely pallid, but without dropsy, except that the face was puffy. The head was hot, the tongue coated, the pulse rapid, 160. The urine was scanty, the colour of dark sherry; when boiled the clot of albumen occupied half the bulk of the fluid. He was ordered to be fed entirely on fluids, including strong beef tea, to drink two pints of spring water daily, and to take half a drachin of the infusion of digitalis, with half a minim of laudanum, three times a day. He had no more fits. The urine increased in quantity and gave a copious deposit of epithelium and epithelial casts. When he had been under treatment for three days all chance of head symptoms appeared to have passed away, and the tincture of sesquichloride of iron was given instead of the opium. On the fourth day the albumen was reduced to a hardly perceptible trace, and on no subsequent examination could any be discovered. Within a fortnight of his coming to the hospital he was in perfect health.* * Several illustrations of the same method to treatment are given in a paper in the Edinburgh Monthly Journal for September 1864. CHAPTER VII. Granula tion. GRANULAR DEGENERATION-MORBID ANATOMY. THE external features of kidneys affected by this disease are so obvious that they cannot be mistaken, while the minute changes by which the outward form has been modified are no less evident to microscopic examination. In using the terms 'granular' and 'granulation,' it must be understood that they refer to the state of surface, as to smoothness or the want of it. A granular kidney is one of which the surface, when the capsule has been removed, instead of being level and smooth, has upon it little projections, each of which forms the segment of a sphere, and which have been described as granulations. Some kidneys there are which, when stripped of their capsule, remain smooth and polished, but which appear to contain in their substance specks of white matter (see p. 26). These have sometimes been described as granular kidneys, but are not granular in the sense in which the term is here used, and are totally distinct pathologically. In kidneys which have acquired granular outsides there has invariably taken place a certain definite change in the fibrous tissue by which the tubes are separated. Of this the alteration of surface is at once the result and the proof. The change is closely analagous to that which produces cirrhosis of the liver. A morbid increase in the intertubular tissue of the organ begins at certain points upon the surface and extends inwards. The new growth as it is formed contracts, and in only from contracting not only encloses and compresses such parts of lar disease. the gland as are in its path, but draws in the surface at its point of origin. This, taking place at regular intervals, Results intertubu |