ADDENDA TO THE DISEASES OF THE KIDNEYS. 377 



tion of the extremities often persists. At times it is a bilateral 

 paresis of the hind quarters, which lasts for weeks, months, or 

 years (a slowness of the posterior members in walking, a stagger- 

 ing, uncertain gait), at times the paralysis is unilateral, localized in 

 certain muscular groups in which progressive atrophy occurs. After 

 hemoglobinemia we have seen a case of chronic spinal meningitis, 

 with paresis of the hind quarters, bladder, and intestine; at the 

 autopsy we found an inflammation of the meninges of the posterior 

 portion of the cord. 



When the disease is goiug to end fatally the paretic phenomena 

 become more and more accentuated ; there is soon a complete par- 

 alysis ; the restlessness of the animal increases, the respiration is 

 dyspnoeic ; scabs appear, produced by the decubitus ; the senses 

 become dull, and death occurs by carbonic intoxication (pulmonary 

 hypostasis), cardiac or uremic syncope. 



Prognosis. The prognosis varies according to the degree of 

 intensity of the morbid forces, but on account of the frequency of 

 the exacerbations it must be formulated with reserve. 



If the animals are no longer able to rise, and especially when it 

 is impossible to keep them standing by means of a suspensory appa- 

 ratus (complete paralysis) there is little hope of recovery. 



The mortality varies according to the race, the climate, the indi- 

 vidual disposition, the degree of intensity of the affection, etc. ; 

 sometimes almost all the patients get well, at other times there is a 

 long uninterrupted course of reverses. Thus the statistics estab- 

 lished by various authors are far from agreeing. Bay has a pro- 

 portion of 70 per cent, of unsuccessful cases (368 were observed) ; 

 Stockfleth says 50 per cent. ; H. Bouley, 60 per cent. ; Grimm, 40 

 per cent. In the Stuttgart clinic we have found it to be 40 per 

 cent., and at Munich it is only 20 per cent. In general the 

 mortality is from 20 to 40 per cent., and in cases of confirmed 

 paralysis, from 50 to 70 per cent. 



Differential diagnosis. Hemoglobinemia may be confounded 

 with a whole series of diseases, the most important of which are: 



1, ColicSy especially the rheumatic forms produced by colds. 

 They are marked by intense pains, the suppression of peristaltic 

 movements and frequent decubitus. The history — mainly the 

 lengthy stay in the stable — will direct the practitioner ; the exami- 

 nation of the croupal muscles, the composition of the urine, the 

 inability of the animals to rise, etc., permit us to make the differ- 



