The three forms of disease just alluded to, viz. acute and chronic desquamative nephritis, and fatty degeneration of the kidney, include the greater number of those cases to which the term " Bright's disease" is commonly applied.
On an inspection of the plates in the 1st vol. of Dr. Bright's well known Medical Re ports, it is evident that more than one form of disease is there described by that distinguished physician. In a paper published two years since*, I maintained that the term Bright's disease should be confined to those cases in which there is fatty degeneration of the kidney,, but after a further consideration of the subject, I am of opinion that if the expres sion " Bright's disease" is retained it should be used only as a generic term- to include several diseases, the existence and the im portance of which were first made known by Dr. Bright, In order to convey a precise idea of the particular form of Brighes disease al luded to, it is clearly necessary to use some terms having a more definite meaning, and I have suggested some which appear sufficiently expressive for the purpose.
Hydatids are occasionally found in the kidney. Dr. Bailliet was well aware of the distinction between true hydatid cysts as they are found in the kidney and the more common serous cysts, which he correctly supposed to arise from an expansion of some of the natural tissues of the kidney. He mentions one case of hydatids in the kidney, in which there was a discharge of these bodes with the urine. It is probable that in every case ofhydatid disease of the kidney, the nature of the affection might be ascertained by a careful examination of the urine. I have already stated that if Mr. Simon's account of the common serous cysts were a correct one, they would be in fact hydatid cysts, and as they would continually escape with the urine, they might be detected by a microscopical examination of the liquid. Assuming, how ever, that they are dilatations of the tubes, it is not surprising that they should never be found in the urine, and that they cannot be dissected out from the kidney after death.
Cancer of the kidney is less uncommon than it vvas formerly supposed to be. It is rarely limited to the kidney, and in the great majority of cases, where other parts are im plicated, the disease has obviously originated in some one or other of these parts.t Can cer less frequently affects the bladder and kidney, sinuultaneously than might be ex pected. M. Rayer and Dr. Walshe have ob served the frequent co-existence of cancer of the liver and right kidney, and of the adjacent parts of the stomach on the descending colon and the left kidney.
In thirty-six of the cases collected by Dr. Walshe, the anatomical state is described with considerable accuracy. " In thirty-one
of these, pure encephaloid or one of its va rities, was the species of cancer observed ; scirrhus in five only, -- two of them of doubt ful character ; while colloid did not, in any instance, occur in this situation. Encepha loid exhibits itself in all degrees of consis tence, and in several of its varieties. Among these varieties, the heematoid may almost be considered frequent, as compared with its rarity in other internal organs. Encephaloid occurs in the infiltrated and tuberous forms; the former more especially when the disea.se is primary, the latter when secondary. Can-. cerous infiltration (as organic diseases gene rally) commences in the cortical substance. This structure may, in some instances, dis appear altogether under the influence of the accumulating cancerous matter, without the tubular substances having suffered in the least. The nodular form of the affection like wise originates in the cortical substance, ge nerally near the surface ; as the masses en large, they become prominent on the surface, and assume the appearance of having formed between the surface of the kidney and its capsule." The renal tissue between the can cerous masses is sometimes quite healthy; but in other instances it is congested, in flamed, or actually in a state of suppuration, the pus being infiltrated or accumulated in a single spot. Melanotic discolouratiou of the cancerous masses is occasionally, but rarely, witnessed in the kidney. In thirty-five cases of renal cancer, the disease affected both organs sixteen times ; the right alone thirteen times, the left alone six.* In concluding this brief sketch of the pathology of the kidney, I will venture to predict that, within a very short space of time, the diseases of the kidney will be more completely and generally understood with reference to their pathology, diagnosis and treatment than those of any other organ. There are two circumstances which justify such an anticipation :-1. There is perhaps no important organ in the body whose minute structure has been so com pletely and so clearly demonstrated as that of the kidney has been by Mr. Bowman. And 2nd, The morbid deposits or accumulations to which the kidney is liable occur, almost without exception, in such a situation, within the uriniferous tubes, that portions of these materials are being continually washed out by, the stream of liquid which is poured into the extremities of the tubes, and so they conie within the sphere of our daily obser vation ; thus affording the pathologist and the practitioner an opportunity- of ascertaining the nature and tracing the progress of disease vvhich is not presented in the case of any other internal organ.