35
them, and the portal veins are also distended with blood-cells ; around the disten-
ded central and portal veins there is fine granular pigmentation of the liver cells.
Engorged vessels are usually seen well just beneath the capsule of the liver, and
there may be haemorrhages here. The nuclei of the liver-cells stain badly and
the cells have a cloudy indistinct appearance as of parenchy matous degeneration.
Spleen.—The vessels generally, both large and capillary, are distended with
blood-cells, and this is more marked in certain distinct areas ; here a dilated
vessel is seen full of blood and round it an area of engorged capillaries, with
haemorrhage into the spleen tissue, blood-cells being seen amongst the spleen-
cells. Engorged vessels are also seen in some glorimeruli, and a vessel distended
with blood leading to the glomeruli ; further distended vessels with haemor-
rhages around them are usually well marked under the capsule of the spleen.
Section of spleen stain well and the cells are distinct.
Kidney.—The vessels, both large and capillary, are distended with blood-cells
at places, vessels have ruptured and hemorrhage is seen into the kidney sub-
stance. This condition is marked immediately beneath the capsule. Blood-cells
are seen in many of the tubules, but more so in. the straight than in the convu-
luted tubes, and some of the glomeruli are likewise engorged. The epithelium of
the tubules is swollen and in a condition of parenchymatous degeneration and
the nuclei of the cells stain badly ; but this condition is more plainly seen in the
convuluted than in the straight tubes. Some specimens show engorged vessels
with hemorrhage at the pelvis of the kidney.
Ureter.—The vessels of the walls of the ureter are distended with blood, and
haemorrhage has occurred into the walls, blood-cells being seen in the mucous
membrane even as far as the lumen ; the condition is similar to that found in
the walls of veins.
Stomach and Intestines.—The vessels are distended with blood, this condi-
tion being best seen in the sub-mucosa ; at places small haemorrhages have
occurred. The epithelium does not stain well. Nothing abnormal was seen in
Peyer's patches.
Brain and Spinal Cord.—The large vessels and capillaries of the pia mater
are distended with blood, but no special changes have been seen in the substance
of the brain or spinal cord.
Muscle.—In specimens of voluntary muscle some fibres are seen well-stained
and distinctly striated, but mixed with them are others which are badly stained,
with striation faint or absent, and the muscle-substance is swollen, broken up
into irregular lumps and of a shiny homogeneous appearance. Specimens of the
heart-muscle showed this condition also.
Note.—This degeneration of heart-muscle is associated with the dilatation
of the heart and nutmeg condition of the liver found post-mortem ; and also with
the fact that plague-patients are liable to die suddenly of heart-failure.
Blood-vessels.—In the outer coat of large arteries the blood-vessels are found
full of blood, and the capillaries of the middle coat may also be seen distended ;
but the inner coat is always perfect, distinct and intact, and its elastic tissue
plainly visible. The walls of large veins, however, show much more engorge-
ment, and, in these, large collections of blood may be seen immediately beneath
the inner coat, extending as far as the lumen, and at parts the inner coat is
either extremely thin or cannot be traced over the haemorrhage. This condition
is best seen in vessels incorporated in a bubo, but is also to be found in the vena
cava, iliac veins, &c.
The following organs were also examined, but nothing was observed under
the microscope except some engorgement. The tonsils, salivary glands, thyroid
body, breast, male and female generative organs, cartilage, nerve and thoracic-
duct. Sections of the skin were also made and showed engorged capillaries with
small hcemorrhages where petcchice were visible on the surface.
B.—THE SEPTICJEMIC FORM.
Lymphatic Glands.—The areolar tissue around the plague-glands (i. e., the
characteristic glands already described) shows none of the intense engorgement
seen in the bubonic form. The plague-glands themselves are well stained and