DR. BRIGHT and subsequent pathologists have fully recognised that the granular contracted kidney is usually associated with morbid changes in other organs of the body. The disease in the kidney and the co-existent morbid changes are commonly grouped together and collectively termed "chronic Bright's disease." In this communication we propose to consider the pathology of this morbid condition. We are induced to do this because our observations tend to show that the present prevailing pathological theories do not fully comprehend the whole history of the disease. It is, we believe, generally assumed that the kidney is the organ primarily affected, and in consequence a cachexia is induced through which other organs subsequently suffer and 1 By Sir William Gull, Bart., M.D., D.C.L., F.R.S., and Henry G. Sutton, M.B., F.R.C.P. Reprinted from the Medico-Chirurgical Transactions,' vol. lv, 1872, p. 273. undergo chronic changes. How far this opinion is well founded we now proceed to examine. It will be advantageous first to consider the morbid changes in the kidneys, and subsequently the morbid changes which occur in other parts of the body. The morbid anatomy of granular contraction of the kidney is generally so well known that it is needless here to fully describe it, though it is necessary to recount some of the histological changes which may be observed in this state. For our examinations some sections were made of the diseased kidneys without any hardening process; others were made after freezing: some sections were faintly stained by a weak solution of nitrate of silver, others by carmine, and others were left in a natural state. The examination was made by and inch object-glass, and the following changes were noticed. A fine fibroid or hyaline-fibroid substance was seen between the convoluted tubules, which made the tubules appear wider apart than normal. In some parts this substance had a homogeneous appearance, in others it had a striated or fibroid appearance like a network, and contained minute indistinct nuclei (?), and in others it had a coarser and more defined fibre-like character. This substance was seen in considerable quantity round the Malpighian bodies, and in still greater amount in and around the walls of the minute arteries. In some renal arterioles injected with Beale's blue translucent fluid the elastic tissue of the tunica intima was normal. The muscular tissue appeared to be changed in some of the vessels-it seemed thicker than natural, particularly when the arterioles were viewed longitudinally. The muscular nuclei were indistinct, and many of them were so altered as hardly to be recognisable. External to the muscular nuclei there was a quantity of hyaline-fibroid substance, and the layer formed by this material was much thicker than the muscular layer (Plate VI, fig. 7). This hyaline-fibroid was in some of the arterioles bounded externally by a few coarser fibres; in some it merged imperceptibly into the fibroid tissues lying between the tubules. tortuous. The arterioles were often very much thickened and and narrowed, and in some it seemed completely obliterated. The morbid material here alluded to had in and around the walls of some of the arterioles very little hyaline appearance, but was more coarsely fibrous. Many of the convoluted tubules were not appreciably altered, except that their epithelium was more or less granular. Others were much shrunken and wasted. Here and there a quantity of the fibroid material was noticed, arranged in a concentric manner; and in the centre of the coil were a few indistinct, shrivelled, scarcely recognisable epithelial cells. fibroid coils apparently enclosed atrophied tubules. of the tubules were irregularly dilated, or apparently formed a number of cysts. In some situations almost all trace of tubular structure had disappeared, and scarcely anything but fibroid tissue remained. When the cortex was very much contracted the Malpighian bodies were found lying very much closer together than normal, and surrounded by a considerable quantity of fibroid tissue (see Plate V, fig. 1). These In an early stage of granular contraction of kidney, when there are no changes appreciable to the naked eye, except that the surface of the kidney is, as technically called in the post-mortem room, "coarse," the following alterations may be observed. In the walls of some of the minute arteries, and also outside and around them, there appears to be an excess of fibroid tissue, and the arteries in consequence seem thicker than normal. The number of arterioles thus affected varies very much. Those most altered are in the cortical parts. In making this observation we are well aware that there is normally more or less of areolar tissue around the minute renal arteries, therefore it is difficult with any degree of certainty to appreciate any slight increase in such tissue; but after careful observation it seemed to us that the outer coats of the arterioles even at this early stage were thickened by increase of fibroid tissue. The muscular tissue did not appear increased. The intertubular tissue seemed also altered in some parts. It was abnormally distinct and clearly defined. The fibre-like appearance was unduly marked as contrasted with the normal kidney intertubular structure. Immediately under the capsule, and corresponding to the depressions of the granular surface, fibroid tissue ex |