Hcemoglobincrmia. — Azotcsmia. — Etc. 453 



weak and imperfect, the faeces small in quantity and dry, and 

 the bladder atonic so that the urine may have to be drawn off 

 with the catheter. It usually retains the deep red color, or im- 

 provement may be heralded by a change to a dirty grayish hue. 

 If, however, it shows an excess of albumen, cylindroid casts en- 

 tangling renal epithelium and white or red globules it will indi- 

 cate the access of diffuse nephritis and a prolonged or even a 

 fatal illness. 



When control of the limbs is not restored at the end of a week, 

 the paretic mu.scles usually undergo marked and rapid wasting, 

 which may la.st for months or years. This is especially common 

 in the case of the patellar muscles (muscle of the fascia lata, tri- 

 ceps extensor cruris ) in which the atrophy may become so ex- 

 treme that the skin covering the inner and outer sides of the 

 thigli may be brought virtually in contact in front of the femur. 

 This entails an almost complete inability to sustain the body on 

 the hind limbs. When atrophy is less extreme, there is only a 

 weakness, stiffness, or swaying or staggering on the hind limbs 

 in progression. 



In fatal cases death may occur early in connection with the 

 violent struggles, tlie excited breathing, pulmonary hypo.stasis 

 and congestion, a cyanotic hue of the visible mucous membranes 

 and a gradual increase of stupor. Though delayed for several 

 days, there is a continuation of the muscular struggles, and the 

 labored breathing ; the red or glairy character of the urine per- 

 .sists or is exaggerated ; the nervous irritability increases, with 

 muscular trembling ; and cyanosis, or stupor increases until death. 



The mortality is always high in the severe forms of the disease, 

 the deaths ranging from 20 per cent, upward. 



After a first attack there is a .strong predisposition to a second 

 under similar exciting conditions. 



Diagnosis. The peculiar symptoms of this disease and the 

 circumstances attending its onset, are usually sufficient to dis- 

 tinguish it from all others. There may be danger of confounding 

 certain cases with thrombosis of the posterior aorta, or of the 

 iliac arteries or their branches, but the absence, in such cases, of 

 the special history of the attack and of the morbid state of the 

 urine, and the absence of pulsation in the arteries distal to the 

 thrombo.sis will serve to prevent confusion. Spinal myelitis will 



