95
ignorance, we unconsciously were allowing deaths to remain unreported, which were
110 doubt attributable to plague. In an old thesis I possess on plague, the patho-
logical changes in the lungs are fully described, but no importance was attached to
the result as an infecting medium. It states :
"The lungs have an inflammatory appearance and are engorged, or they may
bo of a deep black or livid colour, with their vessels distended by a thick dark-coloured
blood, and their substance softened, in some instances chequered, by livid stripes
or patches, swelled or enlarged so as to project occasionally from the chest."
No notice appears to have been taken of the condition of the glands in the lungs.
It is possible, however, where death takes place rapidly in primary pneumonia,
that there may be no noticeable enlargement of the glands ; but where this was
absent, I think, if a careful search were made, it would be found that some other gland
liad become affected. In Table A it will be noted that 34 pneumonic cases had a
glandular accompaniment in some region or other, although it is correct to assume
that 75 per cent, of these 34 cases had secondary pneumonia, taking their origin in
lisomorrhagie stasis, and proceeding to inflammation through the immediatede com-
position of blood and the low vitality of the individual.
The next interesting topic to discuss is the mode by which the bacilli
gain an entrance into the system and produce the disease.
In the face of all the expert opinion recently in Bombay, this matter is not so
simple as first appears. If we accept the current conclusions arrived at that three
sources offer this opportunity, there would be no reason for further argument,
viz., through wounds, abrasions or other openings of the skin or mucous membrane,
through the lungs, or by way of the alimentary canal.
To take the inoculation cause first—if we believe it—this is easily explained ;
and for our purpose wo will take an inguinal case.
An open surface exists about the foot or ankle. It must be an oldish wound,
abrasion or ulcer, as a new wound or cut is practically sealed by serum—coagulation
on its surface, likely to exclude any microbe from entering or being absorbed.
The finest lymphatic vessels, or capillaries, exist as a plexiform network in
the connective tissue. They are, therefore, in contact with this open space ; these
capillaries as they diverge or recede from their superficial position form small
channels, which from anastamores become larger till they converge towards the
deeper glands situated in the femoral or inguinal region. The microbe is supposed
to bo absorbed by the capillary system conveyed along the channels with the
lymphatic fluid till it reaches a gland where it (or they) becomes located. Here
its fission or multiplication begins, and during this process a toxine is produced,
which is eventually set free and carried on in its direct course with the lymphatic
fluid till it gets into the general circulation, and sopticæmia results. Meanwhile
the gland has altered, There is tension, congestion, infiltration, serous or hæmor-
rohagic, into its substance, variable enlargement, more so below than above, with
acute pain. If more than one set of glands are implicated, it is probable that the
second or third sets are a secondary sequence, arising from a primary gland becom
ing infected—that is, through the medium of the toxine, and not actually by the pre-
sence of microbes. In only a small portion of those attacked are bacilli found in the
blood, and if they are, the possibility is that they escape from the gland by exosmosis
when there is great hæmorrhagic infiltration through the walls of the veins lying
in proximity or contact with the diseased gland. The presence of these bacteria
prognosticates an unfavourable issue, especially if they are found early with a high
21