I 



29 



A review of the literature on the subject of glomerular thrombosis 

 was published in Bulletin Xo. 23. 



CONCLUDING REMARKS. 



In conclusion we wish to emphasize again the frequent occurrence 

 of renal hyaline fibrin thrombosis in bubonic plague. We have 

 found this histopathologic change in nearly 40 per cent of our 

 cases, viz, in seven out of the first series of twenty and in five out 

 of the second series of eleven. As the familiarity of the oljserver 

 with this condition increases, his ability of finding it macroscopic- 

 ally becomes greater. In those cases in which we find very profound 

 thrombosis, this process probably extends over the entire cortex ; but 

 in those of moderate intensity it is found, it appears, only here and 

 there throughout the cortical tissue. Therefore in such cases as the 

 latter one must be critical in the selection of the microscopic mate- 

 rial. Quite generally the congestion and engorgement of the kidneys 

 in plague is very great, and the enlarged glomeruli stand out as 

 dark-red points on a contrasting background of cloudy and grayish- 

 3-ellow convoluted tubules, but the glomeruli obliterated by fibrin 

 thrombi themselves assume a granular, shining, grayish-white ap- 

 pearance, and they may, after a little practice, easily be recognized 

 with the naked eye. 



Our plague material, which is in no way an exceptional one, but 

 on the contrary an average typical collection of cases, justifies the 

 conclusion that plague in man is, among all human diseases in 

 general, the one in which highly characteristic hyaline thrombotic 

 processes in the glomeruli and in the renal vessels at largo are most 

 frequently encountered. These important processes have heretofore 

 not been sufficiently considered, wrongly interpreted, and generally 

 have been altogether overlooked. In the literature of plague a • 

 hyaline degeneration of the vessel walls in the kidneys and in other 

 organs is frequently mentioned, but, as pointed out by the author 

 in this publication and in previous ones, we are not concerned at all 

 with such a condition, but with primary hyaline thrombotic processes 

 presenting in the elements of the vessel wall themselves only occa- 

 sional and couiparatively very insignificant secondary degenerations. 

 Likewise in tlie jilague ])ul)o we are generally encountering primarily 

 a true hyaline tlin)nil)osis, and only later, after general tissue 

 necrosis in consequence of enormous Ijacterial invasion, do we find 

 extensive degeneration and complete necrosis of the vessi'l Avails. 



