On a New Way of Treating Gonorrhœa

Abstract

tive process li:ke the desquamation of the cuticle is frequently attended by injurious results, which are entirely absent in scarlatina, for no accumulation of cuticle can possibly take place. On the other hand, Frericks considers that the desquamation is only an accidental consequence of an effusion of albumen and fibrin, which entangles the epithelium after coagulating in the tubes 'and carries it off in its escape into -the pelvis of the kidney. It is a difficult task -L decide upon so delicate a point, but there can 'be no doubt of the fact that epithelial scales are found in the urine to an enormous amount, and -are perfectly diagnostic of the disease. In order to distinguish between acute and chronic desquamative nephritis with certainty, it is necessaxy to examine with the microscope whether the epithelial scales are entire or disintegrated, the acuteness of the attack being capable of estimation by the proportion of perrect cells found, and also by the presence of 'lood corpuscles, which are rarely found in the chronic form. The symptoms, pathology, and treatment of these diseases are given in an admirable style, and with great minuteness, indeed, so much so, that it is out of the question to attempt any ,analysis in the limited space we can afford. But there is one point which has caused a considerable controversy, between our author on the one 'hand, and Mr. Simon, followed by Rokitanski sad Paget on the other. This point of dispute 'is relative to the primary cause of renal cysts. Dr. Johnson maintains that they are simply dilated tubes, and that there is no difficulty in tracing them through every degree of dilatation from the natural size up to cysts visible to the naked eye. He also says that with care he can always detect, in contact with these cysts, unequivocal portions of elongated tube, having the same structure as the other parts, and evidently continuous with them, though this is concealed by the tissue in which they are enveloped. On the other hand, Mr. Simon contends that they are abnormal developments of epithelial germs, his theory being that, " certain diseases of the kidney, (whereof subacute inflammation is by far the most frequent,) tend to produce a blocking of the tubes; that this obstruction, directly or indirectly, produces rupture of the limitary membrane; and that then, what should have been the intra-mural cell-growth, continues, with certain modifications, as a parenchytic development." For the argaments pro and con, we must refer our readers to the book itself, for though highly interesting they are too long for insertion. Another disputed point is as to the development of new fibrous tissue; but here our author and Mr. Simon are both opposed to its occurrenoe except in very rare instances. But it appears that desquamation does not alwavs coexist with nephritis: and hence we must not always give a favourable prognosis on the absence of epithelial scales from the urine. Indeed, according to our author, if you have nephritis unaccompanied by this epithelial desquamation, the danger is much increased, and in chronic cases we frequently find, that instead of the morbid poison being eliminated, fatty degeneration of the kidney takes place in the granular form, terminating but too frequently in death. The mottled variety of fatty degeneration, on the contrary, is rarely preceded by nondesquamative nephritis, and is a slow insidious disease, not even to be detected by a microscopio examination of the urine. The remaining chapters-viz,, the eighth. ninth, and tenth, are occupied with a description of nephritis when followed by a secretion of pus; scrofulous disease of the kidney, cancer, and luematuria. Each of these sections is exceedingly interesting, but still as they have received no remarkable elucidation from the investigations of our author, we need only remark that they embody all that is known on the respective subjects. Having thus alluded1 as far as our space wiU allow, to this highly interesting work of Dr, Johnson's, we have only to recommend our readers to examine it and judge for themselves, as to the accuracy of his views. With regard to treatment we have yet much to learn, but as we have gained one step in advance from the correct anatomy to the pathology of the kidney, so we hope hereafter to progress still further in the successful treatment of those diseases, which are even now less under the control of medicino than we hope will eventually be the case.