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between the peritoneum and gall-bladder. Similar haemorrhages behind the
peritoneum were found on the surface of the spleen, kidneys and intestines,
and sometimes large coagula in the retro-peritoneal tissue of the lumbar
region.
Circulatory System.—The pericardial cavity usually contained a few ounces
of blood-stained or clear fluid, and petechial haemorrhages were constantly seen
beneath the visceral and parietal pericardium. The heart-muscle was either
normal or in some cases rather soft and friable ; considerable dilatation of the
right side, with post-mortem clots in the cavities, was often present. There was
not much engorgement of the walls of arteries, but the vena cava and other
large veins showed this condition very markedly. On opening the veins distinct
petechial and larger haemorrhages were seen under the inner coat, giving it a
mottled appearance. Where a large vein, e. g. axillary or femoral, was included
in the bubo, this heemorrhage into its walls was constantly seen so that the
extravasated blood in the gland itself, in the areolar tissue outside it and in the
walls of the vein was all directly continuous. I think that the blood itself
was rather more fluid and showed less tendency to clot than is usually seen after
death.
The Respiratory System.—There was some engorgement of the larynx and
trachea, and the mucous membrane of the bronchial tubes was usually swollen
and engorged, sometimes greatly so. There was much general engorgement of
the lungs with oedema, and small haemorrhages into the lung tissue were seen
rather frequently. Erothy sero-mucous fluid which was sometimes blood-tinged
was found in the bronchi. The pleura showed marked engorgement, and its
cavity often contained some blood-stained or clear fluid ; sub-pleural haemor-
rhages, sometimes of large extent, were commonly found on the upper surface
of the diaphragm, on the chest-wall and on the surface of the lungs, especially
between the lobes. In cases of cervical bubo the engorgement and oedema
extended to the larynx, and oedema of the glottis was present.
Note.—A variety of the bubonic form of plague must be mentioned here ; for,
instead of finding one large bubo, such as has been described above, the
following condition was observed. A chain of enlarged glands was found in
the inguinal region and it extended into the pelvis right along the iliac aitery
as far as the lumbar glands. These glands were dark-red, soft and friable and
intensely engorged and looked like soft spleen tissue ; there was great engorge-
ment, extravasation and oedema around them, and they surrounded the iliac
artery and vein, so that in dissecting out the gland mass these vessels came
away enclosed in it. The glands were as large as almonds or smaller and
were so incorporated in the coagulated blood that it was scarcely possible to
dissect them out. The remaining glands and other organs in the body were
in the condition described above.
B.—THE SEPTICAEMIC FORM OR PLAGUE-SEPTICAEMIA.
In the bubonic form of plague, one set of glands with extravasated blood
around them forms the bubo, and there is practically no alteration in the remain-
ing glands of the body ; but in the septicsemic form there is no such bubo, yet
there is a general involvement of nearly all the lymphatic glands. Yet though
so many glands show evidence of disease, one gland or several glands of one set
show characteristic changes which are pathognomonic of this type of plague.
These appearances are :—The gland is enlarged to the size of an almond or less,
is rounded, firm and pink in colour ; on section it shews some but not much
engorgement and some œdema, its substance is rather soft and can be easily
scraped off with a knife, and sometimes small softening areas were present.
There was no hoemorrhage in the areolar tissue around this gland and at most
only a little œdema and trifling engorgement of the vessels. Commonly there
were one or several such glands in one inguinal region, and usually the lowest
gland of the chain was most markedly affected ; whilst those higher up varied
in size from a bean to an almond, and had the same firm pink appearance, though
there were at times some which looked nearly normal in size and shape. The
iliac glands of the same side were similarly affected, as large as almonds and
either pink and firm or softer and of a dark red colour. The inguinal glands of
the opposite side showed similar changes, but sometimes to a less extent, and