S6
[CHAP. II.
Π.—REPORT BY SURGEON-CAPTAIN L. F. CHILDE, I Μ. s.
I. —ON THE POST-MORTEM APPEARANCES OF PLAGUE.
THE bodies examined were for the most part those of well-nourished adults of the
servant and labouring classes. Usually the skin was found intact, except that there were
cracks and abrasions about the hands and feet, resulting from occupation, and also in many
cases marks of the common parasitic skin diseases, especially ringworm and itch ; and
although clinically various skin-lesions were met with, such as sloughing at the site of the
bubo, boils and ulcers, yet in these cases recovery generally took place, and I had no
opportunity of observing such conditions in the post-mortem room.
The following varieties of plague were met with :—
The Bubonic Form.
The Septicæmic Form or Plague-Septiæomia.
The Pneumonic Form or Plague-Pneumonia.
A.—THE BubONIC FOrM.
Bubonic Plague.
The bubo was usually situated in the groin of either side, less commonly in the axilla,
rarely in the neck, and most rarely in the supra-trochlear or
popliteal region ; the limb corresponding to the bubo was
swollen and ædematous and petechiæ were usually seen
upon it, but they were always in greatest number over the site of the bubo itself; and
though there might be some over the body generally, still these were but few. In the case
of an axillary bubo, the whole axilla looked full and smooth, and the swelling extended
down the side nearly to the margin of the ribs, down the inner part of the arm to the elbow,
and over the anterior and posterior axillary folds. Ou dissection there was an enormous
mass of dark coagulated blood and serum which occupied the whole axilla and included the
glands, so that the whole mass had to be removed together ; and on incision this was found
to consist of the connective tissue of the part gorged with blood and of coagula due to
hemorrhages, whilst within were seen the glands. In recent cases, of four or five days'
duration, there were some of a deep red and some of a lighter red colour, but all intensely
engorged and solid, not breaking down, but a little soft from the amount of blood in them ;
whilst in older cases, of seven or eight clays, the glands were softer, more pink in colour
and almost diffluent, suggesting in fact the appearance of a rather soft spleen. The glands
were rounded or oval in shape, and varied in size from a walnut to a pea. As a rule, too,
the smallest glands were the deepest in colour and most solid, whilst the largest were of a
lighter red colour and softer consistence. The axillary vessels were pressed upon and
surrounded by the enlarged glands and extravasated blood, so that in fact they became
incorporated in the bubo, and it was mainly by this pressure on the axillary vein that the
œdematous condition of the arm, as referred to above, was produced. The hæmorrhage
and coagula extended beyond the axilla and were found in the arcolar tissue, as well as
amongst the muscles, but more between them than in their substance ·, this condition also
extended down the arm and could be seen in the areolar tissue as far as the elbow. There
was also much clear ædema fluid which assisted in forming the swelling, and it was found
in the axilla as well as beyond its borders. The bubo thus was found to consist, not of a
single enlarged gland but of a chain of glands of various sizes, surrounded by a mass of
engorged areolar tissue, coagulated blood and ædema fluid.
In the case of a bubo in the groin there was a similar diffuse swelling in Searpa's
Triangle extending to the neighbouring parts ; whilst when the bubo was in the cervical