42
F.-CASE OF PLAGUE.SEPTICEMIA. WITH SECONDARY DEPOSITS IN THE
LIVER, AND PNEUMONIA WHICH WAS NOT DUE TO PLAGUE.
S. D., Hindu, female, aged 60, was admitted on 9th March 1897. She was
delirious, was in a very weak condition and had some cough ; the inguinal glands
were felt to be enlarged, Lut were not painful ; temperature 102.8. She remained
delirious and very ill, and died on March 12th. The duration of illness was
unknown. Post-mortem examination made two hours after death.
Heart,—Some dilatation of right side.
Lungs.—Old thickened pleura with firm adhesions over both lungs, with
some engorgement and haemorrhage in the adhesions. Considerable engorgement
and oedema of both lungs generally were present. There, was one patch of pneu-
monia in the early second stage, the size of an egg, behind and below the right-
apex ; it was irregularly oval in shape, of a dusky red colour and not distinetly
round and marked off from the lung-tissue, as in the cases of plague-pneumonia
described above.
The Liver was most peculiar ; it was slightly enlarged and congested as in
the early nutmeg condition, and was stuffed throughout with small yellow round-
ed masses in size from pin's heads to peas. They were rather soft and friable
but not fluid, and there was no area of engorgement around them. They were
found both on the surface and throughout the whole substance of the liver. They
looked like necrotic foci.
Spleen, rather large and a little engorged.
Kidneys, senile degenerative changes and a little engorgement.
Intestines, some general engorgement of the stomach and intestines, and
distinct petechiae in the mucous membrane of stomach and large intestine. There
were no deposits in any of these organs such as were found in the liver.
Condition of Lymphatic Glands. Right Inguinal, the lowest was the largest
like a walnut, light red and firm ; the higher ones were smaller and paler and one
of them contained a small softening area.
Left Inguinal, the lowest was like that on the right side and the upper ones
slightly enlarged and red.
Right and Left Iliac, the lowest was like an almond, light red and rather
firm, and the upper ones much smaller and paler.
Lumhar, small and nearly normal.
Bronchial, rather large and engorged.
Swpra-trochlear, right, small and normal-looking ; left, slightly large soft
and pink.
Axillary on both sides, were all red and engorged, and varied in size from
a pea to a hazelnut.
Cervical, like the axillary.
Mesenteric, some looked a little enlarged, soft and pink, and some looked
normal.
Distribution of the Plague-Bacillus. Glands, Right Inguinal—A. consider-
able number of well-stained plague-bacilli.
Left Inguinal—Enormous numbers; on both sides, fewer seen in the smaller
glands.
Right Iliac, a fair number, and Left Iliac many more ; seen best in the large
glands.
°T
he Axillary and Cervical glands showed a few plague-bacilli ; the Right
Supra-trochlear very few and the Left Supra-trochlear an enormous number
just like the large Left Inguinal glands.
'
Liver—In the yellow masses described above an enormous number of dis-
tinct plague-bacilli were seen, whereas the liver generally showed only
a
f
Sections of the liver were also examined and presented the following appear-
anee :-The liver was in the early nutmeg condition, the central veins dilated
with some blood corpuscles estravasated around them, the portal vessels also