On a Case of Diseased Kidneys, With Malformation.

Abstract

PRIVATE William G-, aged twenty-two, a Scotchman, -* in the service four years and three-quarters, was admitted into the Regimental Hospital, at Clonmel, on the 24th of August, from a detachment at Ballinamull, where he had been under treatment fourteen days, for dropsical symptoms. At the period of admission, there was considerable general anasarca of the whole body, together with a quantity of fluid in the abdomen; the skin pale, and pitting on pressure; the countenance very pale; the scrotum much distended; considerable dyspnoea and orthopnoea; pulse very small and feeble, 76; skin cold; appetite tolerable; bowels regular; urine clear and copious. He had suffered previously from syphilis, which had impaired his health.After his reception into the hospital, he derived temporary benefit from combinations of various diuretics, and continued to be alternately somewhat better and again worse, until the 22nd of September, when all the symptoms became much aggravated; the effusion and consequent dyspnaea very great; coma ensued; and he died at two o'clock A.M. on the 25th of September. ' Post-mortem exctmiimtion, twenty-four hours after death.-Head not examined. The chest contained about a pint and a half of serum. The right lung was much congested, and gorged with serum in the inferior lobe and base; tissue healthy. The left lung presented similar appearances to the right. Heart: the pericardium contained five ounces of serum; both ventricles somewhat hypertrophied, and the left contained a firm fibrinous polypus. Abdomen: this cavity contained about two quarts of straw-coloured fluid. Liver slightly larger than normal, and much congested; structure tolerably healthy. Kidneys: the right, situated on the bodies of the fourth and fifth lumbar vertebrse, externally mottled and pale; internally, pale, much indurated, and both cortical and medullary structures in a great measure disorganized, the former presenting the yellow striated appearance indicative of Bright's disease; the latter converted into a condensed, firm, yellow, indurated tissue, imparting much the same feel and appearance, when cut into, as incipient scirrhus. The organ was the normal size. Left kidney found occupying a position immediately above the fundus of the bladder, and below the bifurcation of the abdominal aorta, situated on the sacrovertebral and sacro-iliac symphyses of the left side. It was about one-fourth smaller than the normal size, and of a somewhat triangular or oval shape, with a deep fissure in the external border. On laying it open, a cyst was found occupying the position of the medullary structure, and containing about a teaspoonful of turbid fluid, resembling a mixture of mucus and water, the walls apparently consisting of disorganized cortical tissue, about three-quarters of an inch thick, and of a similar appearance and consistence to the same portion of the right kidney. The right renal artery, two inches in length, given off at the bifurcation of the abdominal aorta. The left renal artery took its origin, distinct from the r...