3. The kidney presents a mottled appearance. It is probably a transition from the first to the second stage.
4. In this stage the kidney is large, dense, and white. The tissues of the kidney have become charged. The urine is scanty, of low specific gravity, and defective in urea and other excretory matters.
5. In this stage the kidney is hard, granular, and contracted. The kidney is 'manlier than in health, the surface is uneven and puckered, the tunic adherent. There is no deposit in the tubes, but fibrous matter has been deposited in the tissues of the kidney, and the tubes are strangulated. The urine may not contain albumen. Its specific gravity is sometimes aglow as 6. This stage has been called the d coarse kidney.' The organ is large and dark. The specific gravity of the urine is high, and it is loaded with urates.
The presence of fatty matter in the casts of the kidneys may occur in any of these stages, and does not appear to exist as a separate form of the disease.
The cause of this disease is anything which will unduly excite the action of the kidney.. Thus it comes on as the result of spirit drinking, which powerfully excites the action of the kidneys. Exposure to cold and diminution of the action of the skin will also produce it. It comes on frequently after scarlatina, when the skin is highly susceptible of any diminution of temperature.
The treatment must be active in the early stages. Purgatives may be given and blood abstracted locally, and the febrile symptoms treated accordingly. Mercury is not found beneficial. When chronic, diapho reties and diuretics are both admissible. Amongst the former, Dover's powder and warm baths, and the latter, bitartrate of potash and digitalis. The patient should be protected from cold ; a warm climate Is serviceable ; and a nutritious but not stimulating diet, with fresh air and exercise, are desirable.
The name of Dr. Addison, physician to Guy's Hospital, has been connected with a diseased condition of the system, which is made apparent by a discoloration of the skin. Hence this disease is also called `Bronzed Skin.' The existence of this discoloured skin has long been known as a symptom of certain cachectic states of the system • but Dr. Addison was the first to point out that this state of the generally existed in connection with a diseased condition of the supra-renal capsules. These bodies belong to the class of ductless glands, and till the time of Dr. Addison'e researches upon bronzed skin appeared, little was known of their uses and functions in the human body. The following conclusions with regard to these bodies have been arrived at by Dr. Harley as the result of his experiments : 1. The supra-renal capsules are not solely fatal organs.
2. They are not absolutely essential to life.
3. The removal of the, right is generally more fatal than the left.
4. That convulsions do not necessarily follow their removal.
5. The absence of their function is attended neither by great emaciation nor debility.
G. If death follows an experiment, it occurs as the result of injuring neighbouring parts.
7. Absence of the supra-renal bodies is not proved to have any special effect in arresting the transformation of hmmatin, or in increasing the formation of blood crystals.
3. The suppression of the supra-renal capsular function is not attended by an increased deposit of pigment in the skin or its appendages.
9. The problem of the connection of the bronzed skin and supra renal capsular disease is more likely to be solved in the dead-hedge than in the physiological laboratory.
These conclusions were chiefly arrived at by experiments on rats, but they would seem to indicate that the connection between the bronzed skin and supra-renal capsules is not clearly made out.
The distinguishing features of the disease to which the name bronzed akin has been given, are general languor and debility, great feebleness of the heart's action, irritability of the stomach, a peculiar change of colour of the skin, and these symptoms usually occurring in connection with a diseased condition of the supra-renal capsules. The general symptoms are in fact those of ammnia, or cases in which the blood is Imperfectly developed. Dr. Addison says of this discoloration of the skin, that it usually increases with the advance of the disease. "The anremia, languor, failure of appetite, and feebleness of the heart become aggravated ; a darkish streak usually appears upon the commissure of the lips ; the body wastes, but without the extreme emaciation and dry harsh condition of the surface so commonly observed in ordinary malignant diseases ; the pulse becomes smaller and weaker, and with out any special complaint of pain or uneasiness, the patient at length gradually sinks and expires. In one ease, which may be said to have been acute in its development as well as rapid in its course, and hi which both capsule's were found universally diseased after death, the mottled or checkered discoloration was very manifest, the anmmie condition strongly marked, and the sickness and vomiting urgent; but the pulse, instead of being small and feeble as usual, was large, soft, extremely compressible, and jerking on the slightest exertion or emotion, and the patient speedily died." (Addison.) Although the connection between the state of the skin and the disease of the capsules was exhibited in all Dr. Addison's original cases, many exceptions have been recorded. .Cases have occurred in which extensive disease of the supra-renal capsules has occurred without any bronzed skin, and cases of bronzed skin have been seen where no disease of the supra-renal capsules could be detected after death.