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[CHAP. II.
G.—THE PNEUMONIC FORM OR pLAGUE-PNEUMONIA.
Plague- Pneumonia.
In this form of plague the only marked evidences of disease are found in the lungs,
whereas the lymphatic glands and other organs are scarcely
affected at all. The lungs were in the following condition :—
There was general engorgement with considerable œdema,
a reddened condition of the mucous membrane of the bronchi, but no marked evidences
of bronchitis, and frothy watery fluid, sometimes blood-stained, could be squeezed from
the bronchi. (Pus in the bronchial tubes was only found on one occasion. ) A number
of pneumonic patches were found scattered through the lungs, varying in size from a pea to an
egg. These patches were light pink or red grey in colour, solid, airless and sank in water ;
they were rounded in shape and usually separated by a distinct ring of engorgement from
the crépitant lung around. Some, instead of being pink, were of a deep blood colour
throughout and less solid, and some of these had a small greyish more solid centre. Those
of the patches which were situated on the surface of the lung were prominent and
projected distinctly from the surface ; whilst the pleura over them was roughened and
showed signs of early inflammation. These patches had in fact the appearance of the first
and second stages of lobular pneumonia, but no patches were found which had passed on
to the third stage of softening and breaking down. In a few cases larger masses of
pneumonic lung than these were found, and once about half the lower lobe was found in
this condition. Petechial hæmorrhages were usually found on the surface of the lung,
the bronchial glands were either enlarged, swollen, œdematous, soft and distinctly engorged,
or else they were small and of the usual appearance, perhaps a little engorged. The
remaining lymphatic glands throughout the body showed none of the appearances of either
the bubonic or septiceemic form of plague ; most of them looked absolutely normal, and
the only noticeable change was that the axillary, and sometimes the cervical chains, were
a little engorged.
The description of the remaining internal organs already given applies equally to
this form of plague, except that the large hæorrhages were absent, but petechiæ on the
surface of the heart, in the pelvis of the kidney, bladder, stomach and intestines were
commonly present. Petechise in the skin were not observed in this form of plague.
Reference must be made here to a variety of this form of plague which may be described
as a combination of Plague-Pneumonia with Plague-Septicsemia. In this condition the
lungs were found in the state which has just been described, pneumonic patches being
scattered through them ; and in addition the lymphatic glands of the body presented the
appearances seen in cases of Plague-Septicæmia. Thus in these cases the plague-bacilli
had specially infected both the lymphatic glands and lungs, whereas in the varieties of
plague, treated of above, only one or other of these tissues was the special focus of disease.
II.—MICROSCOPIC PATHOLOGY OF PLAGUE.
A.—THE BUBONIC FORM.
The areolar tissue round the glands of the bubo is intensely engorged, free hemorrhage
is seen in the areolar tissue and fat, and all the vessels visible are full of blood, and their
walls deeply engorged. The glands are uniformly full of extravasated blood through-
out, with more intense hæmorrhages here and there, and the gland tissue is so overlaid
with blood as to be scarcely visible ; in some, probably earlier, glands the blood-cells are
distinct ; in others, probably older, they are not so distinct, and the gland is stained with
blood-colouring matter, softer, showing granular débris, and beginning to break down