MEDICAL ASPECTS OF PLAGUE.]
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Curvícal, as large as hazelnuts, deeply engorged and œdematous, and some with a little
hæmorrhage into the surrounding connective tissue.
Supra-trochlear, as large as peas and engorged.
Alimentary System.—Tonsils small, slightly engorged, œsophagus rather engorged, but
no hæmorrhages in its Avails ; there were distinct petechise in the stomach, a few in the
small intestine, and more in the colon and rectum; all these parts being likewise engorged.
The sub-maxillary and parotid salivary glands and the pancreas were slightly engorged.
The Breast looked normal and contained good secretion of normal-looking milk, and
its vessels were rather full of blood.
Under the microscope plague-bacilli in large numbers were seen in the inguinal
cervical and axillary glands : they were also present in the blood to a considerable extent.
This account of the pathology of plague is based upon fifty, complete autopsies, of
which twelve were examples of the pneumonic type. Sections for the microscope oí the
various lymphatic glands and organs were made in twenty-three of the cases, and from
these the minute anatomy has been described. Further, in all the cases, many specimens
were prepared to show the distribution of the plague-bacillus in the various parts of the
body, and cultures were made as well in nearly every instance. As the results obtained
from cultures have not been stated above in. the post-mortem descriptions, it will be con-
venient to group them together here. By the method of cultivation the plague-bacillus
has been isolated from the following organs and secretions ;—from the bubo, and, in
septicæmic cases, from plague glands in the various regions (e.g., in one case from the in-
guinal, iliac, axillary and cervical glands) ; from the lung, liver, spleen and kidney ; from
the blood and urine. In one instance the plague-bacillus was proved by Dr. Bitter to be
present in the mucus obtained from the large intestine. In cases of plague-pneumonia
the bacillus could be isolated from the sputum during life, from the fluid contained in the
trachea and bronchi after death, from the pneumonic patches, and in several instances from
the bronchial glands.
IV.—MODE OF EXIT OF THE PLAGUE-BACILLUS FROH THE BODY.
From consideration of the post-mortem appearances it is seen that engorgement and
hæmorrhage are marked features of plague, and further that hæmorrhage is constantly found
on the surface of mucous membranes ; consequently, as soon as the bacillus has entered the
blood of the general circulation, it is possible for it to escape from the body in the hæmor-
rhages on mucous surfaces. Thus in the urinary system blood may be found in the urine dar-
ing life, and after death in the tubules and pelvis of the kidney ; and, besides, there may be
extravasations on the surface of the ureter and bladder ; hence by the urine there is a direct
route for the bacillus to leave the body.
Again in the alimentary system, peteuhito are nearly always present in the stomach,
and as vomiting is a very constant symptom of plague, the bacillus may escape in the
vomit ; similarly, petechiœ are generally found in the colon and rectum, and hence the
bacillus may escape in the fæces. As for the respiratory system, blood may be found in
the alveoli of the lungs in ordinary cases of plague, whilst in cases of the pneumonic type
it is invariably present ; besides, in these latter cases, the bacillus is present in enormous
numbers in the pneumonic patches and in the sputum, and it is extremely probable that
plague-pneumonia for this reason plays an important part in spreading the disease. (In
the preceding section the secretions have been named from which the plague-bacillus was