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D.—THE PNEUMONIC FORM.
B. F., Hindu, male, 23 years old, admitted on January 31st, 1897, complain-
ing of fever and cough of four days' duration. He looked very ill, temperature
102, and he had dyspnoea and cough. There were physical signs of pneumonic
patches in the lungs. He complained of no pain whatever, nor was any enlarge-
ment of lymphatic glands made out. He remained very well and died on
February 2nd. Post-mortem examination seven hours after death. No petechiae
on surface of body, body well-nourished and plenty of subcutaneous fat.
Heart.—Muscle rather soft and flabby and dilatation of the right side with
slightly coagulated blood in the cavities. "
Lungs.—Much general engorgement and oedema of lung-substance, some
congestion of bronchial mucous membrane, with frothy sero-mucous fluid in
trachea and bronchi. Distinct rounded nodules in the early second stage of
pneumonia were distributed in the lungs as follows :—There were five such
nodules in the right upper lobe, varying in size from a hazelnut to an egg, and
a few in the rest of this lung, with one mass quite at the base; also the left
lung contained a few similar pneumonic patches. Those on the surface projected
and there was early pleurisy over them, also petechiae under the parietal pleura,
generally. The nodules were surrounded by a ring of engorged lung in the
first stage of pneumonia. The liver, spleen and kidneys were large and engorged,
and the bladder full of urine ; the intestines rather engorged with some petechiea
in the stomach, the brain and its membranes engorged.
Condition of Lymphatic Glands.—Bronchial, enlarged and a little swollen
and engorged.
Cervical, normal ; Axillary, a little swollen, mostly on the right side.
Supra-trochlear and Popliteal, normal.
Inguinal, slightly enlarged.
Iliac, Lumbar and Mesenteric, normal.
Distribution of the Plague-Bacillus.—The pneumonic lung in the second
stage shows immense numbers of early well-stained bacilli, and some of them are
collected into large masses or groups ; the pneumonic lung in the first stage
shows the same appearance, but not so many of the masses. The general lung-
tissue shows many of the bacilli, but far less than the pneumonic patches. The
fluid obtained from the trachea and bronchi also shows the bacilli in large
numbers. The bronchial glands contained plague bacilli in considerable numbers.
The spleen showed a few, the liver rather more and the kidneys still more,
but nothing like the numbers in the lungs. The blood of the general circulation
showed extremely few, just one here and there.
The axillar} 7 and cervical chains, the lumbar, iliac, mesenteric and inguinal
glands showed extremely few, only one here and there as was seen in the blood.
Thus the plague-bacilli were present in enormous numbers in the lungs and
only to a very slight extent in the lymphatic glands and remaining organs.
Note.—In some other cases of the pneumonic form of plague, fewer of the
bacilli were seen in the bronchial glands and kidneys than in this instance.
E.—PLAGUE-PNEUMONIA WITH PLAGOE-SEPTICJEMIA.
K. B., Hindu, 31 years of age, was admitted on February 23rd, 1897, for
fever and cough, said to be of five days' duration. He was extremely ill and
there were physical signs of pneumonic patches in the lungs ; also enlarged
glands could be felt in the groins and axillae. His temperature varied between
103 and 105, delirium set in, and he died on February 2Cth. Post-mortem on
February 27th, twelve hours after death ; there were no petechiae on the skin.
Heart.—Right side dilated, muscle rather soft.
Lungs.—Much blood-stained, watery fluid in trachea and bronchi, much
general engorgement and oedema of lungs. There were many distinct, solid
pneumonic patches, each surrounded by a well-marked ring of engorgement ;