33
the iliac sometimes showed slighter changes or some of them looked normal.
The lumbar usually showed slight enlargement and were either pale and soft or
somewhat pink and firm. The cervical and axillary varied in size from hazel-
nuts to peas and usually shewed merely engorgement, being full of dark blood ;
but sometimes some of them showed the pink firm appearance described above.
The mesenteric were enlarged to the size of peas and beans and were either
slightly or considerably engorged. The supra-trochlear and popliteal were normal
or engorged. There was no haemorrhage or œdema around any of the above-
mentioned glands, and no enlargement of the lymphatic vessels was observed.
The condition of the remaining organs was such as has already been described
under the bubonic form.
Note.—In several cases of plague-septicaemia where death had occurred
shortly after attack, the glands were found slightly enlarged of a dark red colour
and contained much blood and œdema fluid. This appeared to be an earlier form
of the characteristic pink plague glands described above. The difference between
the bubonic and septicémie form of plague appears to be this :—In the bubonic
form the plague bacillus after entering the body is arrested at the nearest group
of glands, grows here rigorously, and as a result of its growth the bubo is formed.
Here the bacillus forms the toxins which are discharged into the system and cause
the symptoms of plague, but the glands of the bubo form a barrier which prevents
the bacilli from passing on and growing generally throughout the body ; and it
is only shortly before death, in fatal cases, that this resistance is overcome
and the bacilli are able to pass on into the system generally. But in the septi-
csemic form the bacillus, after entering the body, meets with feeble resistance at
the nearest glands; it speedily overcomes all opposition and passes on to infect
other glands and organs where it grows abundantly. These points will be illus-
trated later in the detailed account of autopsies.
It may be mentioned here that no bubo of the mesenteric glands was ever
found ; these glands were always examined, and though changes might be found
in them, they were always less marked and less distinct than plague glands found
in other parts of the body. In short, there was no autopsy which went to show
that the plague bacillus had reached the stomach or intestines, e.g. in food, and
thence infected the mesenterio glands.
C—THE PNEUMONIC POEM OR PLAGUE-PNEUMONIA.
In this form of plague the only marked evidences of disease are found in
the lungs, whereas the lymphatic glands and other organs are scarcely affected
at all. The lungs were in the following condition :—There was general engorge-
ment with considerable œdema, a reddened condition of the mucous membrane of
the bronchi, but no marked evidences of bronchitis, and frothy watery fluid, some-
times blood-stained, could be squeezed from the bronchi. (Pus in the bronchial
tubes was only found on one occasion.) A number of pueumonic patches were
found scattered through the lungs, varying in size from a pea to an egg. They
were light pink or red grey in colour, solid, airless and sank in water ; they
were rounded in shape and usually separated by a distinct ring of engorgement
from the crepitant lung around. Some, instead of being pink, were of a deep
blood colour throughout and less solid, and some of these had a small greyish
more solid centre. Those of the patches which were situated on the surface
•of the lung were prominent and projected distinctly from the surface ; whilst
the pleura over them was roughened and shewed signs of early inflammation.
These patches had in fact the appearance of the first and second stages of lobular
pneumonia, but no patches were found which had passed on to the third stage
of softening and breaking down. In a few cases larger masses of pneumonic
lung than these were found, and once about half the lower tube was found in
this condition. Petechial haemorrhages were usually found on the surface of
the lung ; the bronchial glands were either enlarged, swollen, oedematous, soft
and distinctly engorged, or else they were small and of the usual appearance,
perhaps a little engorged. The remaining lymphatic glands throughout the
body showed none of the appearances of either the bubonic or septicsemic form
of plague ; most of them looked absolutely normal, and the only noticeable
change was that the axillary, and sometimes the cervical chains were a little
engorged.
B 1751—9