

x,B,4 Crowell: Pathologic Anatomy of Bubonic Plague 308 
as to fill the pelvis with blood. The fat and areolar tissue about 
the pelvis of the kidney may also be the seat of extensive hzem- 
orrhage, especially on the side on which extensive retroperi- 
toneal hemorrhage occurs about primary buboes of the second 
order in the lumbar glands. The hemorrhages occurring in 
the renal parenchyma may be numerous and punctate on the 
outer surface and in the cortex. These for the most part occur 
in the glomeruli, constituting, along with the degeneration, a 
true hemorrhagic glomerulonephritis. However, such a condi- 
tion occurs in a relatively small proportion of the cases. 
The glomeruli in some cases appear pale, lusterless, and 
elevated. Focal areas of necrosis, not larger than 2 millime- 
ters in diameter, were seen twice (1969, 2989). In both cases 
there were other metastatic plague foci in the viscera. 
The ureters show no marked lesion other than the presence 
of hemorrhages in and about them. Punctate hzmorrhages - 
on the mucosa occur. Frequently the ureter on the side on 
which the femoral bubo occurs is completely surrounded by, and 
embedded in, hemorrhagic retroperitoneal tissue, and this heem- 
orrhagic condition may not only be about the ureter, but may 
extend through its walls so as to be visible on the mucous surface 
at localized portions. 
The urinary bladder may similarly show punctate hzemor- 
rhages on its mucous surface; no other change has been en- 
countered. 
HISTOPATHOLOGY OF THE KIDNEYS 
The morphologic changes occurring in the kidney are im- 
portant and frequently characteristic. They consist essentially 
of a degeneration of the tubular epithelium and an intracapillary 
glomerulonephritis. Changes in the vessels also occur as well 
as some cedema and hemorrhages, but cellular reaction in the 
form of evidence of regeneration or exudation is minimal or 
lacking. 
The epithelium of the primary convoluted tubules undergoes 
a marked granular degeneration with swelling of the cells. Fre- 
quently hyaline masses appear in the cells and the latter become 
broken up. Necrosis of these cells with their desquamation into 
the lumen frequently occurs. Very seldom are other cellular 
elements found in the tubules, except occasionally red blood 
cells. A granular material is practically always present in the 
distended tubules. 
Congestion of the vessels is frequently marked between the 
tubules, both in the cortex and in the pyramids. Small hzem- 
