MEDICAL ASPECTS OF PLAGUE.]
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region this swelling was enormous, and pressed upon and embarrassed the larynx and
trachea (hence the dyspnæa in these cases). With regard to the remaining lymphatic
glands of the body in a bubonic case, there is but little to be said. Thus in the case of a
left axillary bubo the following condition was found. The left supra-trochlear gland was
intensely engorged and the size of a large bean, rather firm and full of dark blood ; the
right supra-trochlear, right axillary, cervical of both sides and bronchial looked normal or
just slightly engorged. The mosenteric, iliac, lumbar and popliteal were in the same
condition ; whilst the inguinal were some as large as beans, pinkish, and slightly engorged
others of about the normal size and appearance. It may be mentioned here that the
lymphatic vessels presented no abnormality as a rule, except that in some cases those near
the bubo seemed to be slightly swollen; the thoracic duct, too, was either normal or possibly
slightly swollen.
Condition of the other Organs.—Haemorrhages were frequently found beneath the con-
junctivas, in the connective tissue under the scalp, and under the periosteum on the surface
of the cranial bones, also extravasations sometimes of large size were occasionally found
amongst the muscles, especially in those of the abdominal wall. The occurrence of petcchiæ
in the skin has been already mentioned.
Nervous System.—The dura mater and pia mater were much engorged, and the appear-
ance of lymph was seen along the course of the larger vessels in the latter membrane ; the
puncta cruenta in the brain were well marked, but the brain substance itself looked normal,
as did the fluid in the ventricles. The spinal cord presented a similar engorged appearance,
but showzed no other abnormality, and the nerve-trunks appeared to be normal.
Alimentary System.—The tonsils were either normal or enlarged to the size of almonds,
of u dusky purple colour, soft and engorged ; und similarly the pharyngeal tonsils were either
normal or engorged. The parotid and sub-maxillary salivary glands were either normal or
engorged to some extent, the mucous membrane of the pharynx and æsophagus was usually
dusky from engorgement. The stomach showed constantly a distinctly engorged appear-
ance with haemorrhages into the mucous membrane, which were usually petechial, but some-
times of a larger size. Similar engorgement and petech'æ were frequent in the large intestine
and rectum, but were less generally found in the small intestine. (This applies especially
to petechiæ. ) In some cuses Peyer's patches and the solitary follicles looked distinct, promi-
nent and slightly swollen ; but usually they were either somewhat distinct or of the normal
appearance.
The Liver was always distinctly enlarged and full of blood, but the substance itself was
usually rather pale and soft from parenchymatous degeneration, there was bile in the gall-
bladder either of the usual appearance or thin and watery. Hæmorrhages into the mucous
membrane of the gall-bladder were rarely seen. In one instance small necrotic patches were
scattered through the liver. This case will be described hereafter.
The Pancreas was either normal or engorged.
The Spleen was always enlarged, sometimes to two or three times the ordinary size,
the capsule was normal, the spleen-pulp of a brick-red or purple colour and always markedly
engorged. It was either fairly firm or rather soft, and the Malpighian bodies plainly seen as
if each were engorged, so as to give the section sometimes almost a granular appearance.
Urinary System. — The kidneys were always enlarged and much engorged, the capsule
stripped easily and petechial hæmorrhages were constantly found beneath it ; the kidney
pubstance itself was pale and soft from parenchymatous degeneration. There was distinct