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who had died of fever, pneumonia or any acute illness, to see if there were evid-
ence that any of them had really died of plague. And at the end of December
I met with a case which had been diagnosed as broncho-pneumonia, but which
turned out to be one of plague affecting the lungs, without causing any marked
enlargement of the lymphatic glands—a case, in fact, of plague-pneumonia ; and
as this post-mortem is exactly like many others that I have since made, and is
typical of the disease, I will give a few notes of it.
B. L., Hindu, male, 25 years old, admitted for fever and cough, December
26th, 1896, under Dr. S. He .said be had been ill for about seven days. He
had symptoms in the chest which, led to the diagnosis of broncho-pneumonia
being made. No lymphatic glands were found to be enlarged or painful, and a
specimen of blood taken by Dr. S. shewed no plague -bacilli under the micro-
scope. He coughed up about two ounces of blood-stained fluid on the night of
the 27th, and died at 3 A.M. on December 28th.
Post-mortem on December 28th, seven hours after death.
Lungs.—Much general engorgement and oedema, with sero-sanguineous
frothy fluid in the bronchi, but no pus; and the usual appearances of acute
bronchitis were absent. There was one small pneumonic patch, the size of a
walnut, in the early second stage, situated a little below the apex on the front
of the right lung-, and two similar but smaller patches at about the same part of
the left lung. These patches stood out a little from the surface and were light
grey in colour, airless, friable and sank in water ; and each was surrounded by a
dark ring of engorged lung in the first stage of pneumonia, which merged into
healthy lung; there was some recent pleurisy over the pneumonic areas. All
the other organs were examined and showed considerable engorgement, but no
special lesion was observed.
Condition of the Lymphatic Glands.—The bronchial were quite small and
of normal appearance ; the cervical were slightly enlarged, but pale and not en-
gorged ; the axillary were pink and slightly enlarged ; the left iliac were some-
what large, red and soft ; the lumbar were swollen but pale ; and all the other
glands looked absolutely normal.
Cultures were mado on agar-agar from the pneumonic lung and spleen, and
ultimately a pure growth of the plague-bacillus was obtained from each.
Microscope.—The pneumonic patches in both stages showed an immense
number of plague-bacilli, and the rest of the lung showed a large number ; the
left supra-trochlear and the left femoral glands shewed a fair number, and all
the other glands extremely few ; the spleen and blood also showed a few.
So this was a case of plague, in. which during life all the symptoms pointed
to disease of the lungs, and in which there were no evidences of glandular en-
largement, whilst after death there was clear proof of enormous growth of plague-
bacilli in the lungs, and of only very slight growth in the lymphatic glands.
I have made up to the present twelve post-mortems on such cases, all pre-
senting appearances similar to the above ; and I may add that all the patients
were brought to hospital by their friends, supposed to be suffering from cough
and fever, and, as far as I know, they were quite unaware of the nature of the
disease. I have also to say that in nearly all the other cases the fluid from the
trachea or bronchical tubes has also been examined ; it shows an immense num-
ber of plague-bacilli, and cultures of plague can always be obtained from it.
With regard to the clinical symptoms of those cases, it fell to me to attend on
the late Dr. Mauser, and as he died of this form of plague, I will mention a few
facts about his case. He was in his usual health on January 2nd, and had a
sudden rigor in the morning and felt fever coming on. During the day a bad
headache developed, he felt nausea and vomited several times, and he had pains
and a tired feeling in his limbs; his tongue remained clean and moist, and his
skin was slightly moist. At 2 P.M., temperature 103.4, pulse 116, respiration 25,
and there were but slight variations during the day. On January 3rd, had pass-
ed a bad night and felt worse, and all the symptoms persisted, except the aching
in the limbs, and he felt very ill. The temperature remained between 103.5 and
104.5, pulse about HO, and respirations about 23 throughout the day. During