8 



the kidney in tliis discasu: nor does tlu' desi-i-i[)tion of Hanidi (who 

 worked under ^lai'cliand) mention it at all. Ilamdi had at his 

 disposal material from seven plague cases and pieces of kidney from 

 five. His description of the renal changes reads as follows: 



111 our case.s of plague the glomeruli vary in appea ranee. Tliey are 

 generally large, show many nuclei, and then fill the capsular space com- 

 pletely. Their capillaries are dilated and engorged with blood. Occasion- 

 ally bacilli are diffusely distributed in these loops. In other cases, 

 howevei-. the glomeruli are small and the capillaries contain little blood. 

 Jf tills is the case and if the capillaries are collapsed, the capsular space 

 contains a coagulated amorphous mass or a hyaline-like {hyalinartige } 

 substance or blood, the latter being found also between the loops. 



Since reporting the investigation of twenty cases of hnbouic 

 plague, and since becoming acquainted with the above-quoted publi- 

 cations, the writer has examined eleven more typical, fatal pest 

 cases. We can now not only confirm our former statements as to 

 renal vessel changes in plague l)ut can further support them by 

 additional observations and by additional staining methods em- 

 ])loyed in the investigation of the material. 



The statement of Albrecht and Gohn, that the renal vessel changes 

 which they have seen, but which they have misinterpreted, are to be 

 found only in those cases in which numerous plague bacilli are cir- 

 culating in the blood, we must contest, because our own investigation 

 shows, as previously stated (Bulletin No. 23), that the presence or 

 absence of l)acterial metastatic emboli and the occurrence of hya- 

 line fibrin thrombi do not entertain toward each other the relation 

 of cause and effect. These two factors are indeed independent of 

 each other, though they may Ije ])resent simultaneously. A number 

 of our cases demonstrate this beyond question. We saw very pro- 

 found renal thrombotic processes without bacterial invasion and 

 very extensive bacterial emboli in the absence of thrombi. Duerck 

 likewise reports cases in which he speaks of the Ijacterial inundation 

 of the kidneys without mentioning thrombosis. Of his case No. T 

 he reports : "Everywhere in the capillary loops of the glomeruli and 

 in other vessels numerous plague bacilli were found." Case No. 9 : 

 "Most glomeruli inundated by plague bacilli." Case Xo. 11 : "Bac- 

 terial stains show an enormous inundation witli plague bacilli : manv 

 glomeruli appear as if they had been injected with bacteria : like- 

 wise other renal vessels." In none of these cases are thrombotic 

 processes proper mentioned. 



