MEDICAL ASPECTS OF PLAGUE.]
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B.—THE SEPTICÆMIc, FORM, OR PLAGUE-SEPTICAEMIA.
Plague Septicæmia.
In the bubonic form of plague, one set of glands with extravasated blood around them
forms the bubo, and there is practically no alteration in the
remaining glands of the body ; but in the septicémie form there
is no such bubo, yet there is a general involvement of nearly
all the lymphatic glands. Yet though so many glands show evidence of disease, one gland
or several glands of one set show characteristic changes which are pathognomonic of this
type of plague. These appearances are : The gland is enlarged to the size of an almond or
less, is rounded, firm, and pink in colour ; on section it shows some, but not much, engorge-
ment and some œdema ; its substance is rather soft and can be easily scraped off with a
knife, and sometimes small softening areas were present. There is no hemorrhage in
the areolar tissue around this gland and at most only a little œdema and trifling engorgement
of the vessels. Commonly there were one or several such glands in one inguinal region, and
usually the lowest gland of the chain was most markedly affected ; whilst those higher up
varied in size from a bean to an almond, and had the same firm pink appearance, though
there were at times some which looked nearly normal in size and shape. The iliac glands
of the same side were similarly affected, as large as almonds, and either pink and firm or
softer and of a dark-red colour. The inguinal glands of the opposite side showed similar
changes, but sometimes to a less extent, and 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 showed 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 hemorrhage 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-septicemia, 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 septicæmic 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 vigorously, 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 septicémie form, the bacillus, after entering
the body, meets with feeble resistance at the nearest glands ; it speedily overcomes all oppo-
sition and passes on to infect other glands and organs where it grows abundantly. These
points will be illustrated 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 intestine, e. g., in food, and thence infected the mesenteric glands.
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