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moist coffee-grounds; rubbed between the fingers it gave a slightly gritty feel; removed from the body it soon became dry, and could be broken up into a fine powder.

The pyramids were nearly a dark slate color, and apparently were infiltrated by the same substance found in the pelvis.

The cortex was normal in quantity and appearance.

Microscopic examination of the mass found in the pelvis was negative, there being nothing seen but amorphous granular matter. No crystals of any sort were seen.

A microscopic section of the kidney showed that all the urinif. erous tubes were filled with a highly refractive brown material.

Where the section had struck the tube longitudinally, it seemed to be completely filled, the walls were bulged out, and their outlines were quite irregular.

The normal epithelial cells lining the tubes could nowhere be seen. Transverse section, however, in some of the tubes showed that a central channel still existed, the brown substance being ad. berent to the walls, and apparently taking the place of the usual Jining cells. All of the collecting tubes of the larger size were thus affected; the convoluted and looped tubes, as well, showed in places the same condition. The glomeruli were rather more opaque than usual. The blood vessels could not be satisfactorily followed; no injection of them was made. The connective tissue was unchanged except at points, where there seems to be an in. filtration of germinal cells.

The bladder was found normal in all cases, sometimes contain. ing a little brown fluid, but never any deposit. The mucous membranes were not examined.


The following examination was kindly furnished by Dr. Mac. kenzie, Pathologist.

Urine.-The urine was quite turbid, and of a dirty-brownish color. After it had stood for some hours, a brownish-gray deposit subsided, but the supernatant fluid did not become perfectly clear. Specific gravity 1012. Reaction neutral. Boiling slightly di. minished the turbidity; the same effect was produced by the addition of nitric acid, and liquor potassæ also rendered it somewhat clearer. In no case, however, was the influence of these agencies at all well marked, the urine remaining after their application quite turbid. A specimen of the urine was filtered, and the filtrate, treated with heat and nitric acid, gave evidence, by be. coming somewhat cloudy, of the presence of a small quantity of albumen. Another specimen, boiled with a small quantity of nitric acid, filtered, and then evaporated to a quarter of its bulk, did not, upon the addition of equal parts of nitric acid, give rise to the formation of crystals of nitrate of urea, thus indicating that, if present at all, the urea must have been very small in quantity.

When examined microscopically, the deposit presented a per. fectly amorphous appearance, not unlike that of the amorphous urates, but much darker in color. No blood-corpuscle nor any other formed element of definite shape could be detected.

The dark material so frequently passed with the urine was on several occasions examined for hæmine crystals by Teichmann's method (the addition of chloride of sodium and glacial acetic acid), but the results were invariably negative.


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The urine subjected to examination by Dr. Mackenzie was ob. tained by the nurse, who held the child several hours, waiting for its escape. After an ounce or two had been passed, a mass of pig. ment material was arrested at the end of the urethra, and gently squeezed out.

Two dried specimens of the dark substance, one taken from the pelvis of a kidney, the other from the end of the urethra, were forwarded to Jos. G. Richardson, M.D., well known to the profession as an accomplished pathologist and microscopist, who very kindly examined them and gave me the negative result. His language is: “The material seems to be almost if not quite insol. uble in water, glycerine, cold alcohol, boiling alcohol, and boiling sulphuric ether. Under the microscope, it is seen on pressure to break with a conchoidal fracture, and to have a fine granular structure, which even beneath a high power (2000 diameters) exbibits no trace of blood-corpuscles, or of cellular elements, epithelial or otherwise in their character. Exposed gradually to the heat of an alcohol flame (upon platinum foil), it swelled up, partially fused, then took fire and burned with a yellow flame, emitting a strong animal odor, and finally left a mere trace of orange-gray ash.”

Subsequently, I sent to Dr. Richardson one of the lighter col. ored kidneys for examination. The following letter is expressive of his views, and is given entire. Indeed, it will scarcely admit of abbreviation.


No. 1620 CA ESTNUT St.,

PHILADELPHIA, May 15, 1875. M. B. WRIGHT, M.D.

Dear Sir: I forward herewith, for your inspection, a thin section of that very interesting kidney you sent me by express on the 8th inst. It is cut perpendicularly to the surface of the gland, nearly through the axis of one of the pyramids, and under a magnifying power of from 50 to 100 diameters, you will see a beautiful display of the uriniferous tubules, brought most clearly into view, in consequence of their having become filled with a granular matter, yellowish in their smaller convoluted, and brownish in their larger straight portions. This granular material, which has obviously been ejected in considerable quantities from the apices of the cones, no doubt under the influence of compression and per. haps chemical action, formed the dark substance of which you last month sent me samples, and which, if carefully examined in its moist state, would probably have exhibited traces of its constituent cylindrical tube casts. Beneath a high power, I was able to positively distinguish that these casts still occupying the tubules were made up of red blood-corpuscles. By tinting a very thin section with aniline or iodine (according to the method I employ for the diagnosis of blood-stains), I found it easy to measure the mag nitude of the aggregated red disks, and with a power of 2000 to determine their average diameter in one particular sample (even in a specimen which had been treated with absolute alcohol, clarified with oil of cloves, and mounted in damar), at zo'oz of an inch.

Since no visible alteration in the renal parenchyma could be detected, the malady producing a fatal result in this case appears to have been a simple hemorrhage from the kidney, the “Népbrorrhagie” of Lebert, although it must be admitted that the profuse flow of blood from the capillaries may possibly have been a symptom of the first stage of ante-tubal nephritis cut short in its incipiency by the death of the patient.

Accepting either hypothesis, however, such disease, occurring coincidently in your hospital to two new-born children, is certainly an event of great interest and rarity, since Dr. Dickinson, in his exhaustive monograph (Pathology and Treatment of Albuminuria, New York, edition 1868, p. 29), declares that antetubal nephritis “is nearly unknown during the first year of life;" whilst Prof. Lionel S. Beale (Kidney Diseases, Urinary Diseases, and Calculous Disorders, Philada. 1869, p. 387 et seq.) does not give any account of hæmaturia of very young infants; nor has Prof. H. Lebert, in his magnificent Traité d'Anatomie pathologique (Paris, 1861, tome ii. texte, p. 349), made any reference to renal hemorrhage of the new born.

Hoping this brief report, made under the pressure of numerous engagements, may be of service to you,

I remain, dear sir,
Respectfully yours, etc.,

Microscopist to the Pennsylvania Hospital.

After much research, I can find no allusion made to pigmentation among infants, in any of the periodicals or standard works. The remarks of Billard under the head of "Spots or Nævi Materni,” can scarcely be construed as bearing upon the subject before us. He

He says in reference to these spots, " they present 'nothing more than a simple change in the cutaneous pigment, and are in reality a peculiar property of the skin."

In his Anatomical Description of Pigment Liver, and of the Coexisting Conditions of the Spleen, Brain, Kidneys, etc., Frerichs says in regard to the diseases of adults, "the kidneys frequently participate in the pigmentary deposit to a remarkable extent. When this is the case, gray spots make their appearance in the cortical substance; and in a few cases we may observe dark lines in the pyramids following the course of the blood vessels and uriniferous tubes. Under the microscope we can detect the pigment matter in the capillaries of the cortical substance, and particularly in the Malpighian bodies; now and then we find isolated little fragments in the uriniferous tubes."

We have no opinions to express in regard to the character of malignant malarial fever, nor theory to support as to the origin of the pigment associated with it. Most observers have credited its formation to the spleen, and while Frerichs admits “there are many grounds for such an opinion,” he says, “we must keep in view, à priori, the possibility of the same blood metamorphoses taking place in other parts of the body, and we cannot arrive at the conclusion that these changes are exclusively confined to the spleen, until observation lends no support to the participation of other parts of the vascular system." In a chapter on “ Marsh Fevers ” Trousseau observes, “I must


not omit to mention a pathogenic theory promulgated in Germany by men whose works I exceedingly esteem. The theory to which I refer attributes the pernicious symptoms to pigmentary embolia.

"This change of color” in the liver "is due to the accumulation of pigmentary matter in the vascular apparatus of the organ; the liver is pigmented.” “The spleen presents exactly similar lesions." “We also find black pigment in the capillaries of the lungs." "It is likewise found in the brain.” “The pigment is the result of the transfusion of the bæmatine; and this transformation may take place anywhere, even external to the vascular system."

I have not been able to find the report of a single case of pig. mentation among infants, until the Boston Medical and Surgical Journal, March 11, 1875, was placed in my hands. The leading paper in that number of the journal is entitled "An Unusual Result of Septic Poisoning, Discolored Skin," etc. Ten cases are there given, taken from the records of the Boston Lying-in Hospital, and worked into an ingenious essay (graduation thesis) by William Sturgis Bigelow. These cases are almost identical with those which have fallen under my observation. The discoloration of the skin, the morbid condition of the mouth, the character of the dejections, and the general exemption from structural lesions are the same. In other respects there was a marked difference. In the former cases there was dark discoloration of the diapers by urine in one only; while in the latter, dark urine and still darker deposits were universal. In the Boston cases coagula were found in the kidneys, ureters, or bladder, or in all at the same time. In the Cincinnati cases not a drop of coagulum, or anything that bore the slightest resemblance to blood, could be found anywhere except in the proper channels.

The two cases quoted from the Archives de Physiologie, September, 1873, and the cases that occurred at "the Hopital de la Maternité at Lyons," more closely resemble those of the Boston than Cincinnati Hospital, inasmuch as hematuria was one of the characteristic symptoms.

The question is naturally suggested, What is the nature of these masses of pigmentary granules? They have been examined by several experienced pathologists and microscopists, in every possible way, and nothing but negative results have been obtained. A careful experimentalist, to whom a mass of pigment material was given without any explanation as to its source, remarked " it seems like double burnt cinder."

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