94
[CHAP. II.
In the glands of the bubo the bacilli could be seen in enormous numbers, both amongst the
cells of the gland-tissue and also in the lymphatic vessels ; they were also seen amongst the blood-
corpuscles extravasated into the gland, as well as in the hæmorrhage outside the gland.
In case of plague-septiciemia they were similarly present in the enlarged characteristic
glands. In the kidney the bacilli could also be seen, especially among the blood-cells of the
tubules into which hæmorrhage had occurred : in the spleen they were also present, some-
times in large numbers amongst the cells of the spleen-tissue and in the hæmorrhagic
areas ; similarly they were found in the liver, especially in those cases where engorgement
and extravasation were marked.
In case of plague-pneumonia, the bacilli were seen in abundance in the pneumonic areas;
they could be found in profusion amongst the catarrhal epithelial cells and leucocytes which
filled the alveoli and terminal bronchioles, as well as among the blood-corpuscles of the
alveoli into which hæmorrhage had occurred. Similarly in the lungs of non-pneumonic
cases they could be seen, but in far less numbers, and mostly where small hæmorrhage
had occurred into the alveoli.
Note.—These specimens were only prepared from cases where the post-mortem was made
immediately after death, and in which the presence of the plague-bacillus had been proved
to be present by the method of cultures, so as to avoid the fallacy of diagnosing plague-
bacilli from their microscopic appearance alone.
III.—CASES TO ILLUSTRATE THE VARIOUS FORMS OF PLAGUE.
A.—THE BUBONIC FORM.
Bubo in the Left Axilla.—R. N., male, Hindu, aged 40 years, admitted 1st March 1897,
says he got suddenly ill four days ago with fever and severe rigors ; temperature on
admission 104 . 8 F., pulse 110, has pain in left axilla. March 2nd.—Temperature 103 . 2,
pulse 110, still pain in left axilla, and swollen glands are felt. During the day a large
doughy, diffuse swelling arose in the axilla, and there was much more pain. March 3rd.—
Temperature 100, the swelling filled out the whole axilla and was very painful. Patient
died at 9-30 A.M.
Post-mortem examination one hour after death.—(Edema and petechicc of left arm; old
abrasions on hands and feet ; large swelling in left axilla, with small petechia) on the skin
over it. The whole of the left axilla was occupied by a mass of coagulated blood and scrum,
and within the mass the axillary glands were found ; they varied in size from almonds to
peas, and were all intensely engorged, deep or lighter red and a little soft; the axillary
Vessels were included in the bubo thus formed of coagula and swollen glands. The hæmor-
rhage and ædema extended beyond the borders of the axilla in all directions.
Left supra-trochlear gland intensely engorged and the size of a large bean.
Right supra-trochlear, right axillary, and cervical chains on both sides were a little
engorged, but of normal shape ; the popliteal were normal ; the inguinal were some as large
us beans, and some smaller or of normal size ; they were all slightly engorged, on the right
side rather more than on the left. The iliac and lumbar were a little engorged, and the
mesenteric slightly so, the bronchial glands looked normal. There was no hæmorrhage or
oedema round any of these glands.
Heart.—Some sero-sanguineous fluid in pericardial cavity and small snb-pericardial
petechiæ ; dark blood in cavities of heart, mostly on right side. Hœmorrhages into walls of
vena cava seen well under inner coat.