43
congested and fat globules in the adjoining liver-cells. The liver-substance was
stained badly and, scattered through it, the above-mentioned masses were seen,
all better-stained than the liver-cells and looking finely granular; some were
large, some small, and some seen under the microscope which were not visible to
the naked eye. The small ones were granular and stained well throughout, but
the large were breaking down in parts and irregularly stained. The small ones
• were distinctly rounded and no liver-tissue was seen in them, but some of the
large were less regular in shape and contained some distinct remains of liver-
cells : these were probably two or three adjoining masses which had coalesced.
Speaking generally, the small masses were mostly situated near the portal spaces,
but this could not be said of the larger, as some were as big as two or three
lobules. Under higher power the masses were seen to consist of leucocytes, pus-
cells, granular "debris and remains of liver cells, and there appeared to be an
excess of leucocytes in the surrounding capillaries ; in fact the structure of the
masses resembled that of small early abscesses.
Specimens of the liver were also prepared to show the plague-bacilli in situ
in the sections ; enormous numbers of them could be seen in the masses and only
a few in the general liver-tissue.
Cultures also were made from the masses, and typical colonies of the plague-
bacillus grew in abundance. Thus these small necrotic masses resulted from the
growth of the plague-bacillus in innumerable definite areas throughout the whole
liver, and are comparable with the pneumonic patches found in cases of plague-
pneumonia due to the same cause. This condition of the liver was extremely
rare and was only observed in two other cases during the Bombay epidemic, once
by the Austrian and once by the Russian Plague Commission. No similar con-
dition was ever found in the spleen or kidneys to the best of my belief.
Lung.—Cultures made from the pneumonic patch showed the appearance
not of plague but of Fraenkel's Pneumococcus ; and specimens taken from the
patch showed the same pneumococcus under the microscope. Cultures made
from the inguinal and axillary glands, from the spleen and from the heart's blood
all showed the typical growth of plague. These cultures were made by Professor
Bitter, who has kindly permitted me to make use of his results.
Note.—This was the only case amongst the autopsies on plague made by
myself in which secondary pneumonia was found, not due to plague.
(G.—CASE OP PLAGUE IN A PREGNANT WOMAN. SURVIVAL OF THE FOCETUS :
DEATH OF THE MOTHER.
D. R., Hindu woman, 25 years old, was admitted to hospital for child-birth
on 15th April'1897 at 11 P.M. She stated that she was five days short of her
full term of gestation, that for the past several days she had had fever preceded
by rigors, and that a few hours before admission she felt some pains in the
abdomen of a bearing-down character and thought she was about to be confined.
On admission she was examined and fouud not to be in labour, and the pains
were thought to be false. She was quite conscious and able to walk; temperature
102. She stated that she had two children and that her previous confinements
were normal.
On 16th morning, temperature 102, no pain in abdomen, slight pain and
tenderness over right inguinal region, and some glands could be felt a little
enlarged. Patient had a peculiar drowsy expression of features, with injection of
conjunctivas, and looked very ill. The temperature remained high and at 4 P.M.
was 104. At this hour labour pains commenced. She now complained of some
pain in both sides of the neck, and the cervical glands were tender and slightly
enlarged ; also the pain in the right inguinal glands persisted. At 10 P.M. the
patient was very restless ; temperature 105 ; labour was progressing normally.
Ab 10-50 P.M. labour was completed normally. There was no unusual haemorrhage,
merely the average loss of blood. Patient was much exhausted, temperature
102, pulse 140, respiration 72 per minute, with considerable dyspnoea. The
temperature gradually rose to 104, and there was much prostration, dyspnoea and
cardiac failure.