26 



Case Xo. 31. Pkimaky Plagle Septic.?:mia. 



(Necropsy Protocol No. 1082. T. B., Filipina, female, 13 years of age, from 346 

 Cabildo Street, Intramuros. Ill two days. Died January 30, 1905. Postmortem 

 examination made twenty-four hours after death.) 



Anatomic diagnosis. — Multiple subserous and submucous lieniorrluiges ; 

 parenchymatotis nephritis ; congestion and oedema of the huigs. Plague 

 septicaemia. (Smears from the spleen, which is moderately enlarged, show 

 many plague bacilli ; those from the liver, the kidneys, and the glands show 

 a few.) 



Microscopic examination. — Some capillary loops in a few glomer- 

 uli and some extraglomeriilar vessels show hyaline fibrin thrombi. 

 Loose, isolated groups of plague bacilli are found in the tubules, 

 the capsular spaces, and the renal blood vessels. 



SUMMARY OF OBSERVATIONS ON THE VASCULAR 

 CHANGES IN THE KIDNEYS. 



Upon reviewing the results of the examination of 12 cases in 

 which hyaline fibrin thrombi were found in the glomerular capil- 

 laries and in other renal vessels, we arrive at the following general 

 conclusions : 



The thromboses may be of a moderate degree and may be found 

 only in a small proportion of the renal vessels; or they may be of 

 a most extensive character, involving a large number. In general 

 it may be stated that the thrombosis is always most profound in the 

 cortex, and much less so in tlie medulla. However, the latter is 

 never entirely free. As a rule, to which none of our cases were an 

 exception, the thrombosis is always most profound in the glomerular 

 capillaries and in the afferent and efferent vessels. Xcxt in order 

 of frequency stand the interlobular vessels and the intertulmlar 

 capillaries of the cortex. In case of a moderate thrombosis, only 

 a few of the glomerular capillaries are occluded. The rest are free 

 and are then generally more or less engorged with blood; however, 

 they occasionally may be empty and collapsed, but great engorge- 

 ment of the renal vessels is generally the rule in plague. In more 

 severely affected cases a greater proportion of the glomerular vessels 

 is occluded, and the afferent and efferent vessels are likewise obliter- 

 ated. In the ones where the highest degree of thrombosis occurs, 

 it may be difficult to find a single glomerulus in which this has not 

 occurred to a greater or less extent. In such cases thrombi are in 

 fact present in all the different sets of vessels of l)oth cortex and 

 medulla. We find them in the subcapsular glomeruli-free zone, in 



