37
In the glands of the buho the bacilli could be seen in enormous numbers,
both amongst the cells of the gland-tissue and also in the lymphatic vessels ; they
were also seen amongst the blood-corpuscles extravasated into the gland, as well
as in the haemorrhage outside the gland. In cases of plague septicaemia they
were similarly present in the enlarged characteristic glands. In the kidney the
bacilli could also be seen especially among the blood-cells of the tubules into
which haemorrhage had occurred ; in the spleen they were also present, sometimes
in large numbers amongst the cells of the spleen-tissue and in the haemorrhagic
areas ; similarly they were found in the liver, especially in those cases where
endorsement and extravasation were marked.
In cases of plague-pneumonia, the bacilli were seen in abundance in the pneu-
monic areas ; they could be found in profusion amongst the catarrbal epithelial
cells and leucocytes which filled the alveoli and terminal bronchioles, as well as
among the blood-corpuscles of the alveoli into which haemorrhage had occurred.
Similarly in the lungs of non-pneumonic cases they could be seer», but in far less
numbers, and mostly where small haemorrhages had occurred into the alveoli.
Note.—These specimens were only prepared from cases where the post-
mortem was made immediately after death, and in which the presence of the
plague-bacillus had been proved to be present by the method of cultures, so as
to avoid the fallacy of diagnosing plague bacilli from their microscopic appear.
ance alone.
III.—CASES TO ILLUSTRATE THE VARIOUS FORMS OF PLAGUE.
A.—THE BUBONIC FORM.
Buho in the Left Axilla,—R. N., male, Hindu, aged 40 years, admitted 1st
March 1897, says he got suddenly ill four days ago with fever and severe rigors ;
temperature on admission 104.8 F., pulse 110, has pain in left axilla. March
2nd.—Temperature 103.2, pulse 110, still pain in left axilla, and swollen glands
are felt. During the day a large, doughy, diffuse swelling arose in the axilla,
and there was much more pain. March 3rd.—Temperature 100, the swelling
filled out the whole axilla and was very painful. Patient died at 9-30 A.M.
Post-mortem examination one hour after death.—(Edema and petechiae of
left arm ; old abrasions on hands and feet ; large swelling in left axilla, with
small petechiae on the skin over it. The whole of the left axilla was occupied
by a mass of coagulated blood and serum, and within the mass the axillary
glands were found ; they varied in size from almonds to peas, and were all in-
tensely engorged, deep or lighter red and a little soft ; the axillary vessels were
included in the bubo thus formed of coagula and swollen glands. The haemor-
rhage and oedema extended beyond the borders of the axilla in all directions.
Left supra-trochlear gland intensely engorged and the size of a large bean.
Right supra-trochlear, right axillary, and cervical chains on both sides were
a little engorged but of normal shape ; the popliteal were normal ; the inguinal
were some as large as beans, and some smaller or of normal size ; they were all
slightly engorged, on the right side rather more than on the left. The iliac and
lumbar were a little engorged, and the mesenteric slightly so, the bronchial
glands looked normal. There was no haemorrhage or oedema round any of these
glands.
Heart.—Some sero-sanguineous fluid in pericardial cavity and small sub-
pericardial petechiae ; dark blood in cavities of heart, mostly on right side.
Haemorrhages into walls of vena cava seen well under inner coat.
Lungs.—A little blood-stained fluid in pleural cavities, many sub-pleural
haemorrhages of petechial and larger size. Intense engorgement, with some
haemorrhages into lung tissue and some oedema of lungs.
Liver.—Large, and all vessels, both hepatic and portal, gorged with blood ;
liver-substance rather soft; large sub-peritoneal haemorrhages on the surface of
the liver, specially along the ligaments.
Tonsils.—Swollen and engorged ; mucous membrane of stomach and
intestines engorged, and small haemorrhages in stomach and large intestine.
Haemorrhages under serous coat of intestines.
B 1751—10