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II.—Report by Surgeon-Captain Childe, I. M. S.
I.—ON THE POST-MORTEM APPEARANCES OF PLAGUE.
The bodies examined were for the most part those of well-nourished
adults of the servant and labouring classes. Usually the skin was found intact,
except that there were cracks and abrasions about the hands and feet, resulting
from occupation, and also in many cases marks of the common parasitic skin
diseases, especially ringworm and itch; and although clinically various skin-
lesions were met with, such as sloughing at the site of the bubo, boils and ulcers,
yet in these cases recovery generally took place, and I had no opportunity of
observing such conditions in the post-mortem room.
The following varieties of plague were met with :—
The Bubonic Form.
The Septicsernic Form or Plague-Septiceemia.
The Pneumonic Form or Plague-Pneumonia.
A.—THE BUBONIC FORM.
The bubo was usually situated in the groin of either side, less commonly in
the axilla, rarely in the neck, and most rarely in the supra-trochlear or popliteal
region ; the limb corresponding to the bubo was swollen and œdematous and
petechiae were usually seen upon it, but they were always in greatest number
over the site of the bubo itself; and though there might be some over the body
generally, still these were but few. In the case of an axillary bubo the whole
axilla looked full and smooth, and the swelling extended down the side nearly to
the margin of the ribs, down the inner part of the arm to the elbow, and over
the anterior and posterior axillary folds. On dissection there was an enormous
mass of dark coagulated blood and serum which occupied the whole axilla and
included the glands, so that the whole mass had to be removed together ; and
on incision this was found to consist of the connective tissue of the part gorged
with blood and of coagula due to haemorrhages, whilst within were seen the
glands. In recent cases, of 4 or 5 days' duration, there were some of a deep
red and some of a lighter red colour, but all intensely engorged and solid, not
breaking down but a little soft from the amount of blood in them ; whilst in
older cases, of 7 or 8 days, the glands were softer, more pink in colour and
almost diffluent, suggesting in fact the appearance of a rather soft spleen. The
glands were rounded or oval in shape, and varied in size from a walnut to a pea.
As a rule too, the smallest glands were the deepest in colour and most solid,
whilst the largest were of a lighter red colour and softer consistence. The
axillary vessels were pressed upon and surrounded by the enlarged glands and
extravasated blood, so that in fact they became incorporated in the bubo, and it
was mainly by this pressure on the axillary vein that the œdematous condition
of the arm, as referred to above, was produced. The haemorrhage and coapula
extended beyond the axilla and were found in the areolar tissue, as well as
amongst the muscles, but more between them than in their substance ; this con-
dition also extended down the arm and could be seen in the areolar tissue as far
as the elbow. There was also much clear oedema fluid which assisted in forrnino-
the swelling, and it was found in the axilla as well as beyond its borders. The
bubo thus was found to consist, not of a single enlarged gland, but of a chain of
glands of various sizes, surrounded by a mass of engorged areolar tissue coagulat-
ed blood and œdema fluid.
In the case of a bubo in the groin there was a similar diffuse swelling in
Scarpa's Triangle extending to the neighbouring parts ; whilst when the bubo
was in the cervical region this swelling was enormous, and pressed upon and
embarrassed the larynx and trachea (hence the dyspnoea in these cases). With
regard to the remaining lymphatic glands of the body in a bubonic case, there is
but little to be said. Thus in the case of a left axillary bubo the following
conditionnas found. The left supra-trochlear gland was intensely engoro-ed
and the size of a large bean, rather firm and full of dark blood ; the right supra-
trochlear, right axillary, cervical of both sides and bronchial looked normal or
just slightly engorged. The mesenteric, iliac, lumbar and popliteal were in the