137 



rence, which has been more fully described only in connection 

 with late post-scarlatinal nephritis and with swine plague by 

 Welch. It would probably be a thankless task here to attempt an 

 explanation of the formation of hyaline filjrin thrombi in the 

 vessels of the kidneys and of other organs, particiilarly in the 

 infected lymph glands in plague. Indeed, such an attempt at 

 explanation would open up the whole question of blood coagulation 

 and of fibrin formation inside and outside the blood vessels. Loeb 

 has quite recentl}^ published an experimental contribution to this 

 subject With reference to thrombosis and the formation of fibrin- 

 ous exudates he expresses the view that after the removal of the 

 vascular endothelium the specific substances causing coagulation are 

 extracted from the tissues. The ferments acting upon fibrinogen, 

 held in colloidal solution, precipitate it in the form of fibrin. How- 

 ever, in most of our renal sections, in which hyaline fibrin throm- 

 bosis has been seen in the glomerular vessels, the vascular epithelium 

 was to all intents and purposes morphologically intact and well 

 preserved. It is of course not at all unreasonable to suppose that 

 the plague toxines acting as they appear to do in particular upon 

 the kidneys, so damage the vascular epithelium that it becomes 

 pervious to the coagulating ferments, before any morphologic 

 changes indicate a serious functional disturbance. 



THE URINE IN PLAGUE. 



That the kidneys are profoundly afilected in plague is illus- 

 trated not merely by the findings on the post-mortem table and by 

 microscopic examination of the sections but by the clinical history 

 of the disease. 



The Germ.in commission reports that it found albumen in the urine 

 in most cases of plague in which a urine examination was made, while 

 hyaline and granular casts and few or numerous blood corpuscles were 

 seen occasionally. Calmette and Salembini state that it is only in grave 

 cases that the urine is diminished or entirely suppressed. They sometimes 

 saw bloody urine, and always found it very acid and with traces of 

 albumen. Aoyama states that the albuminuria is generally moderate. 

 Bitter formd albimien in most cases, generally very moderate in amount; 

 but in fatal cases it was invariably present. Yamagiwa found albumen 

 only rarely. The Austrian commission examined the urine in fortj^-five 

 cases and found albumen present in all of those where repeated examina- 

 tions were made. The most extensive urine examinations in plague have 

 been made by Cathorn in India. She found albumen absent in only 24. 

 or 7 per cent, out of 341 fatal cases; while in 256 nonfatal cases it was 



