34
The description of the remaining internal organs already given applies
equally to this form of plague, except that the large haemorrhages were absent,
but petechise on the surface of the heart, in the pelvis of the kidney, bladder,
stomach and intestines were commonly present. Petechice in the skin were not
observed in this form of plague.
Reference must be made here to a variety of this form of plague which may
be shortly described as a combination of Plague-Pneumonia with Plague-Sep-
tioœmia. In this condition the lungs were found in the state which has just
been described, pneumonic patches being scattered through them; and in addi-
tion the lymphatic glands of the body presented the appearances seen in cases of
Plague-Septicaemia. Thus in these cases the plague-bacilli had specially infected
both the lymphatic glands and lungs, whereas in the varieties of plague treated
of above, only one or other of these tissues was the special focus of disease.
Allusion must also be made at this place to one case of Plaguo-Septicaemia,
in which the lungs contained a patch of ordinary pneumonia which was not due
to plague. This case will be described in detail later on.
II.—MICROSCOPIC PATHOLOGY OP PLAGUE.
A.—THE BUBONIC FROM.
The areolar tissue around the glands of the bubo is intensely eu gorged, free
haemorrhage is seen in the areolar tissue and fat, and all the vessels visible are
full of blood, and their walls deeply engorged. The glands are uniformly full
of extravasated blood throughout, with more intense haemorrhages here and
there, and the gland tissue is so overlaid with blood as to be scarcely visible ;
in some, probably earlier, glands the blood-cells are distinct; in others, probably
older, they are not so distinct, and the gland is stained with blood-coluring
matter, softer, showing granular debris, and beginning to break down in parts.
Still there is no distinct appearance of pus, and it seems to be a necrotic softon-
ing. In some of the smaller glands the exact early appearance is seen ; the
whole gland is infiltrated with blood, the blood corpuscles being distinct, and
at parts there is a large deeply-stained haemorrhage occupying half or more of
the gland. So intense is the haemorrhage that in most glands there is no dis-
tinction between cortex and medulla, nor can the gland tissue or blood and
lymph-vessels be easily made out, but the walls of such vessels as are seen are
deeply engorged both in the gland as well as at the hilus. Such lymph-vessels,
as can he seen particularly at the hilus, are full of lymph corpuscles, and there
is some engorgement of their walls, and sections of the lymph-vessels, seen out-
side the gland, shew the same appearance. Specimens were cut to shew the
glands of the bubo lying against and around the axillary artery and vein ; here
there is intense engorgement of the walls of these vessels with haemorrhage into
them, but much more of the vein than of the artery ; in the vein the extravasated
blood comes in most parts right through its wall into the inner coat and as far
as the lumen ; so that at these parts the inner coat cannot bo properly seen at
all. Hence one sees the plague gland lying right against the vein, with extra-
vasated blood in the gland in the little "connective tissue outside it, and then in
the vein-wall as far as the lumen ; and thus there is a direct path for the passage
of the plague bacillus from the gland to the lumen of the vein and so into the
general circulation. A similar condition of affairs was observed in those cases
in which, instead of a bubo, there was a chain of enlarged plague glands, e. g.,
along the iliac artery and vein. The remaining glands of the body in a bubonic
case showed either a normal appearance or a little engorgoment of vessels.
Lung.—A section of the lung shows blood-cells in all the vessels as well as
in the alveolar capillaries ; the vessels under the pleura always contain blood,
and large haemorrhages are sometimes present here ; scattered about, areas are
seen where blood-cells are present in the alveoli themselves, and similarly blood-
cells may be seen in the smaller bronchial tubes. The vessels of the walls of
the bronchi, like those of the rest of the lung, are distended with blood ; the
bronchial mucous membrane shows no special change. Specimens of lung
Etain well.
Liver.—All vessels are engorged and the specimen has the appearance of
ear y nutmeg disease. The central veins are wide, as are the capillaries round