170 
DR. BOLLINGER. 
In very severe cases of Bright’s disease, hoemorrhage from the kidneys 
sometimes takes place, ‘but a primary albuminuria with consecutive 
hoemoglobinuria is as yet unknown. Our knowledge of the essential 
changes in the disease in question has been considerably advanced by 
the above-mentioned experiments, which have shown in the clearest 
manner that by certain means—the transfusion of foreign blood—hoem¬ 
oglobinuria may be artificially produced, and in its turn excite an acute 
Morbus Brightii. So in this affection the desquamative nephritis may 
arise, not alone from the increased exercise of the function of the kid¬ 
neys consequent upon the amount of hoemoglobin to be excreted, but the 
unknown “something” which produces the hoemoglobinuria disturbs, 
probably, the nutrition of the parenchyma of the kidney, as it does that 
of the liver and muscles. 
(3-)—The paralytic weakness of the hinder extremities, which often 
appears to usher in the disease, and which is regarded by many authors 
as indicating the existence of some affection of the cord or its mem¬ 
branes, is believed by Dr. Bollinger to depend upon the intense edema 
and resulting degeneration of the inner and superior lumbar muscles, as 
described in case III. The only changes found in the cord have been 
slight hyperamia of the membranes and increase of the sub-arachnoi- 
deal fluid. If the paralysis was spinal in its origin—as held by most 
writers unilateral palsy of one limb would not be so frequent; there 
would be disturbance of sensation—anaesthesia—and also involuntary 
discharge of the faeces and urine, d he possibility of the lumbar region 
of the cord being involved in the collateral edema must also be taken 
into consideration, and in such cases anasthesia would be combined 
with the paresis. 
The author believes the essence of the disease to be in a primary 
blood change, which produces, first, hoemoglobinuria; secondly, an 
acute nephritis with albuminuria ; and, thirdly, by collateral edema of 
the lumbar muscles, and, perhaps, the lumbar portion of the cord—a 
paralytic condition of the hinder limbs. The very evident changes in 
the blood, internal organs and muscles, point, with the hoemoglobinu¬ 
ria, to some poison or poisonous material as the cause of the whole 
process against the view held by many authors that the disease is in¬ 
duced by “ catching cold ” are urged, the sudden, sometimes apoplectic 
form, onset of its violent course, the wide-spread alterations in the or¬ 
gans of the body, and, further, its enzootic appearance and geographical 
extension. It is most prevalent in South and Southwest Germany, rare 
in North Germany and Austria. In Vienna, according to Roll, it is an 
