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ing to confused and undefined ideas concerning the lesions of
those organs. Thus, we find persons, otherwise well informed,
speaking Cost Of Chloroquine of hydronephrosis, acute interstitial nephritis, and
various other kidney-lesions, as if they w^ere diseases of the
•same class and character.
The first step toward a clinical difterentiation of the difier-
ent renal diseases is an accurate knowledge of the morbid
changes Buy Aralen which take place in them.
In the present paper I wish to call attention to those
chronic diseases of the kidney which are most frequently met
with in practice, and to which the name of chronic Aralen Price Bright's
disease is most commonly applied.
For the study of these lesions tlie Bellevue Dead-House
afibrds a peculiarly rich field.
The descriptions of the course and character of this disease,
given by different authors, do not by any means correspond.
The following quotations are taken from the works of the
standard authors on this subject :
Frerichs distinguishes three stages of Bright's disease : 1.
The stage of hyperaemia and of commencing exudation. 2.
The stage of exudation and of commencing transformation of
the exudation. 3. The stage of atrophy.
240 CHEONIC DIFFUSE NEPHRITIS.
The first stage is characterized bj increase of the size of
the kidney, especially of the cortex ; by general congestion ;
by extravasations of blood in Aralen Online Buy Chloroquine the Order Aralen Malpighian bodies, the tubes,
and the kidney-tissue ; and by the filling of the tubes with
coagulated fibrine. The ejDithelinm of the tubes is unaltered.
This is the form of disease which occurs after scarlet fever.
In the chronic form of the disease Aralen Cost all these changes are less
marked.
In the second stage, the congestion diminishes while the
exudation increases. The exudation is found in the tubules
and in the interstitial tissue. The epithelium of the tubes
and the Buy Cheap Aralen exuded fibrine within them breaks down into fatty
granules. The exudation between the tubes is sometimes
organized into connective tissue. The cortex becomes of a
whitish-yellow color, and remains thickened. The surface of
the kidney is Chloroquine Aralen smooth or slightly granular. The pyramids are
of a reddish color. Some of the Malpighian Aralen Phosphate bodies are nor-
mal, others are enlarged, and filled with exudation. In the
cortex the epithelium of the tubes is swollen and granular,
and may break down altogether, or it simply shrivels and
atrophies. The tubes are filled with degenerated epithelium,
granular matter, and fat-globules, or with homogeneous exuda-
tion. The tubes are dilated. The dilatation of the tubes is
tlie principal or only cause of the Purchase Aralen increased size of the kidney.
In the third stage, the kidneys are smaller, or of normal
size, or even larger than normal. The capsule is adherent.
The surface of the kidney is irregular and granular, its color
a dusky yellow. Its consistence is hard. The cortex is
thinned. The pyramids are smaller. The fat about the pel-
vis is increased in amount. The tubes are dilated and filled
as in the second stage, or are collapsed and folded together.
Most of the Malpighian bodies are shrivelled and fatty. If tlie
exudation between the tubes has becoi;ne organized, we find
masses of connective-tissue cells and fibres.
Yirchow says that, in Buy Aralen Online Bright's Order Aralen Online disease, the first change in
the kidney is in the epithelium of the convoluted tubes. The
epithelial cells become swollen and granular. The process is,
therefore, Chloroquine Tablets a parenchymatous nephritis.
George Johnson distinguishes five forms of renal disease
CHRONIC DIFFUSE NEPHRITIS. 241
(excluding tlie suppurative, scrofulous, and cancerous dis-
eases) What Is Chloroquine :
1. Acute Desquamative Nephritis. — The form of disease
occurring after scarlet fever, exposures to cold, etc. This cor-
responds to Frerichs's first stage. Johnson, however, lays
most stress upon the desquamation of the epithelium, and but
little on the exudation in the tubes. Exudation between Purchase Aralen Online the
tubes he does not mention.
2. Chronic Desquamative Nephritis. — This corresponds
to the second and third stages of Frerichs. Chloroquine Price Johnson describes
the degeneration of the epithelium, the denudation of the
tubes Aralen Tablets of their epithelium, their dilatation and collapse, and
the presence of coagulated material within them. The Mal-
pighian tufts are thickened or atrophied. The arteries are
thickened. He regards the production of new fibrous tissue
as an Chloroquine Buy accidental and unessential phenomenon.
3. Waxy Degeneration of the Kidney. — Under this name
Johnson describes kidneys which are of large size, their cortex
thick and white, their tubes filled with waxy material. This
waxy material he supposes to be produced by a degeneration
of the epithelium. The large liyaline casts found in the urine
he calls waxy, and seems to consider them diagnostic of this
form of kidney-disease.
4. 'Acute Non-desquamative Disease of the Kidney. — This
is characterized during life by scanty or suppressed urine, but
containing no albumen, and no casts, or only a few waxy ones.
The kidneys are of normal size ; the epithelium of the tubes is
somewhat altered.
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