Transactions of the Medical Society of King's College, London.

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Credit: Transactions of the Medical Society of King's College, London. Source: Wellcome Collection.

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    epithelium, and if the casts (some or all of them) be dotted plentifully with epithelial cells, and their fragments, we may safely conclude that it is a case of desquamation of the epithelial lining of the tubes, and on the other hand, if there be a large admixture of the pale translucent casts, and little or no epithelium lie scattered about the fields, we may con¬ clude as confidently, that desquamation forms no important feature in the case. Not unfrequently the granular cast presents a yellowish brown appearance due to its being composed wholly, or in part, of broken down blood discs, and the colour, in addition to the presence of free blood cells, furnishes a ready means of recognition. Often the granular cast presents an appearance of extreme blackness, as if it were composed of pigment granules, but I believe that this is rarely due to anything but the extreme degree of com¬ minution to which the crumbled epithelial cells or the fibri¬ nous debris before spoken of, has been subjected. Granular casts occurring as the main constituent of a copious sediment is in most cases an appearance of evil omen, as indicating a wasting of the lining of the kidney tubes, or in fact of the essential part of the secreting structure. They are m most cases the precursors of the large waxy intramembranous cast which I have mentioned as formed in tubes which have become denuded of their epithelial lining, and which offer to the plastic material a smooth mould about ^l^th of an inch in diameter, instead of one of about half that calibie, and made irregular by the presence of epithelium on its walls. 4. Epithelial Casts, (pi. 1, fig 3). These are of course moulded in tubes not denuded, and are therefore of the smaller size; they occur in greatest frequency in cases of acute nephritis, and appear to be examples of a rapid desquamation, and a reproduction as rapid, of the secieting