39
large, dark and full of blood, and the kidneys large, soft and engorged. There
were some petechiae in the stomach, and the brain and its membranes were
engorged.
Distribution of ihe Plague Bacillus.—The enlarged left inguinal glands con-
tained well-stained plague bacilli in considerable numbers; specimens of the left
iliac glands showed them in immense numbers, as did those from the lower lumbar
glands, but the higher lumbar showed less. The right inguinal and iliac, the
axillary and cervical of both sides and the bronchial glands showed only a few
plague bacilli, but of this series the right axillary specimens showed rather more
than the others. The lung, liver, spleen and kidneys similarly contained a few,
as did the specimen of blood taken from the heart; in fact, apart from the bubo
the remaining lymphatic glands and organs merely showed about as many plague
bacilli as the blood,
C.—THE SEPTIC ZEMIC FORM.
P. S., Hindu, male, 30 years old, was admitted on the 19th February 1897.
His friends said he had been ill with fever for about four days and had been
delirious for one day. He died immediately after admission. The post-mortem
examination was made one hour after death. No petechiae on surface of body.
Lymphtic Glands : Right Inguinal.—The lowest was the largest, of the size
of a small almond, and of the others some were nearly as large and some smaller :
they were rather firm and pink and of the characteristic plague appearance.
Left Inguinal.—The lowest was like a small almond, those above quite
small and the highest as large as beaus ; all were slightly firm and pink, but in
an earlier stage than on the right.
Rigid Iliac—The three lowest were like large almonds, pink and firm, but
the upper were smaller.
Left Iliac.—The lowest was like a small almond, but red and full of blood
and rather soft, the upper ones were like small beans and less engorged. The
Lumbar were like small peas and beans, all rather red and firm. The Mesenteric
were enlarged to the sizes of small almonds, beans and peas, and were all dark
red, engorged and soft. The Right and Left Axillary were light red in colour,
and rather firm, some being as large as hazelnuts and some smaller. The Cervical
chains showed a similar appearance, whilst the Supra-trochlear and Popliteal
glands were small and pale.
There was no inflammation of lymphatic vessels and no haemorrhage or
oedema round the glands in this case, so that there was no appearance like the
bubo described in former cases. The condition of the remaining organs was
such as has been already described, and it only remains to notice that there
were many small haemorrhages in the lungs.
Distribution of the Plague-Bacillus.—Specimens taken from the inguinal,
iliac and axillary glands of both sides showed enormous numbers of distinct
well-stained plague-bacilli', specimens of the lumbar and mesenteric glands
showed the same appearance. The cervical glands showed them also, but in
less numbers, and the bronchial, supra-trochlear and popliteal glands still less.
A large number of specimens to show the bacilli were made from the glands of
each region, and, as a general rule, those glands which were largest and most
distinctly altered showed the greatest number of plague bacilli. Specimens of
the spleen contained many of the bacilli, but less in number than the plague
glands. The liver and kidneys showed plenty, but fewer than the spleen, and
the lungs still fewer. The blood contained a fair number, about as many as in
the lung.
Note.—In this case the mesenteric glands showed distinct changes and
contained many plague bacilli, but in some other cases of this type these glands
were only slightly altered and presented a few plague-bacilli : and, as a general
rule, the peripheral glands were most obviously altered and contained the bacilli
in the greatest numbers, whereas the visceral were more normal-looking and
showed the bacilli only in small numbers.