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Spleen.—Large, brick-red and somewhat soft, and many small haemorrhages
under its serous coat.
Kidneys.—Large, and all vessels engorged, the kidney-substance itself
rather pale and soft. Many small haemorrhages under the kidney-capsule and
coagula distending the pelvis of each kidney. Haemorrhages into walls of
ureters and bladder distended with urine.
Distribution of the Plague Bacillus.—In this case the plague bacillus was
found in the various organs as follows:—It was present in enormous numbers
in the glands of the bubo, and in immense but diminished numbers in the blood,
as well as the œdema fluid from the left axilla. The right axillary glands, the
supra-trochlear and cervical of both sides showed a considerable number of
plague bacilli, but far less than the bubo. The lumbar also showed them in
considerable numbers, but they were rather less in the iliac and inguinal chains
of both sides. A few were seen in the mesenteric glands. A specimen of blood
taken from the left ventricle of the heart and from various large veins in the
body showed many plague bacilli, but far less than in the blood taken from the
bubo. Immense numbers were found in the spleen and liver, almost as many as
in the glands of the bubo ; and some, but far less, in the lung and kidney.
In point of fact it appeared from these specimens that the bacillus had grown
most abundantly in the glands and blood of the bubo, and next in the spleen and
liver ; whereas in the remaining lymphatic glands and other organs it was present
in about the same numbers as in the blood of the general circulation, and the
bacilli seen in these specimens were probably those contained in the blood of the
respective organs. Possibly it might have grown to some extent in some of the
lymphatic glands, as indicated by the above specimens.
Kote.—In a case of this nature, where there is extravasated blood around
the glands of the bubo, which extends through all the coats of the large vein (the
axillary in this instance), and where there are enormous numbers of plague bacilli
in this extravasated blood, there appears to be a direct path for the passage of
the plague bacilli into the lumen of the vein and so into the blood of the general
circulation,
B.— CASE OF A BUBO EXTENDING ALONG THE ILIAO VESSELS.
M. R., Hindu, male, aged 27 years, admitted January 26th, 1897, says he
has been ill two days. The left inguinal glands are large, painful and tender
and the left leg is swollen, is much exhausted, and died one hour after admission.
Post-mortem examination made three hours after death. Body well-nourish-
ed, rigor-mortis present.
The Left Inguinal glands were as large as almonds, rather soft, red and
distinctly engorged ; the lower ones showed this condition markedly, but some of
the higher to a less extent. There was no haemorrhage around these glands.
The Left Iliac were all dark red, soft, friable and intensely engorged and
looked like soft spleen tissue ; there was great engorgement, extravasation and
oedema around the glands, and they surrounded the iliac artery and vein so that
the whole mass of coagula, glands and vessels had to be removed together.
There was no rounded bubo as in the former case, but a chain of swollen glands
with haemorrhage around them extending along the vessels.
Lumbar Glands.—The lower ones were rather large, soft and engorged, but
much less than the iliac, and there was but little extravasated blood around them.
The upper ones showed even fewer changes, and some looked normal.
The Bight Femoral and Right Iliac were normal. The remaining glands
looked normal, except that the right axillary were engorged, two of them being
as large as almonds, and the right supra-trochlear was likewise engorged to the
size of a large pea.
With regard to the remaining organs, the heart showed some dilatation of
the right side, and the lungs a great deal of engorgement and oedema; there were
petechiœ under the pleura and pericardium. The liver and spleen were both