10
was beginning to soften at one or two points in the right lung. There were also two or three small masses of grey tubercle in the lower lobes of both lungs. Nearly colourless clots of moderately firm consistence were found in all the cavities of the heart, adhering to the musculi pectinati and chordæ tendineæ, and extending into the great vessels. There were a few small reddish patches of congestion near the pyloric extremity of the stomach. In the lower part of the ileum Peyer’s glands were more prominent than usual, and the mucous membrane was somewhat congested; the solitary glands were also enlarged, and a few of them were opaque and slightly yellow. The supra-renal capsules were both much enlarged and their fibrous envelopes thickened. The right capsule was firmly adherent to the liver, kidney and diaphragm, and the left to the kidney and diaphragm. Both capsules were hard and somewhat nodulated; and, on section, no trace of the normal structure could be discovered, nor any distinction between cortex and medulla. The natural substance of the organs was chiefly replaced by masses of opaque yellow matter, partly of cheesy consistence and partly friable, separated from each other by a greyish semi-transparent tissue of tough consistence. Beneath the thickened fibrous envelope of the right capsule was a small collection of puriform fluid. The disease was apparently less advanced in the left than in the right capsule, there being a larger portion of the greyish semi-transparent tissue, and smaller deposits of the cheesy material, in the former than in the latter.*
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* My friend and colleague
“The capsule, which is still attached to the kidney,
is of the size and shape of a walnut. It is closely invested
with a covering of dense fibrous tissue, about half an inch
in thickness, which is in some parts separable from the
external surface of the organ, in others firmly adherent, and,
as it were, incorporated with it. In the section of the organ
no distinction can be made out between rind and kernel;
but it exhibits several varieties of structure and consistence
without definite arrangement. Some parts are of a pinkish colour,
somewhat translucent, and of firm consistence; others are white,
soft, of a consistence approaching to cream-cheese,
and occasionally gritty. Between these there are various graduations;
thus in many parts the tissue has lost its translucency and colour,
but not its consistence. Between the translucent parts and the
opaque parts there is a great difference in structure,
as shown under the microscope. The former exhibit (even without
the addition of acetic acid, and much more distinctly after the
addition of that re-agent) nuclei which are embedded in a
finely granular stroma. The granular appearance is owing partly
to albuminous granules (which disappear