MEDICAL ASPECTS OF PLAGUE.]
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in parts. Still there is no distinct appearance of pus, and it seems to be a necrotic soften-
ing. In some of the smaller glands the exact early appearance is seen ; the whole gland
is infiltrated with blood, the blood corpuscles being distinct, and at parts there is a large
deeply-stained hæmorrhage occupying half or more of the gland. So intense is the
hæmorrhage that in most glands there is no distinction between cortex and medulla, nor
can the gland tissue or blood and lymph-vessels be easily made out, but the walls of such
vessels as are seen are deeply engorged both in the glands as well as at the hilus. Such
lymph-vessels, as can be seen, particularly at the hilus, are full of lymph corpuscles, and
there is some engorgement of their walls, and sections of the lymph-vessels, seen outside
the gland, shew the same appearance. Specimens were cut to shew the glands of the bubo
lying against and around the axillary artery and vein ; here there is intense engorgement
of the walls of these vessels with hæmorrhage into them, but much more of the vein than
of the artery ; in the vein the extravasated blood comes in most parts right through its
wall into the inner coat and as far as the lumen ; so that at these parts the inner coat cannot
be properly seen at all. Hence one sees the plague-gland lying right against the vein,
with extravasated blood in the gland, in the little connective tissue outside it, and then in
the vein-wall as far as the lumen ; and thus there is a direct path for the passage of the
plague-bacillus from the gland to the lumen of the vein and so into the general circulation.
A similar condition of affairs was observed in those cases in which, instead of a bubo, there
was a chain of enlarged plague-glands, e. g., along the iliac artery and vein. The remaining
glands of the body in a bubonic case showed either a normal appearance or a little
engorgement of vessels.
Lung.—A section of the lung shows blood-cells in all the vessels as well as in the alveolar
capillaries ; the vessels under the pleura always contain blood, and large hæmorrhages
are sometimes present here ; scattered about, areas are seen where blood-cells are present
in the alveoli themselves, and similarly blood-cells may be seen in the smaller bronchial
tubes. The vessels of the walls of the bronchi, like those of the rest of the lung, are
distended with blood ; the bronchial mucous membrane shows no special change. Specimens
of lung stain well.
Liver.—All vessels are engorged and the specimen has the appearance of early nutmeg
degeneration. The central veins are wide, as are the capillaries round them, and the portal
veins are also distended with blood-cells ; around the distended central and portal veins there
is fine granular pigmentation of the liver cells. Engorged vessels are usually seen well
just beneath the capsule of the liver, and there may be hæmorrhages here. The nuclei of the
liver-cells stain badly and the cells have a cloudy indistinct appearance as of parenchymatous
degeneration.
Spleen.—The vessels generally, both large and capillary, are distended with blood-cells,
and this is more marked in certain distinct areas ; here a dilated vessel is seen full of blood,
and round it an area of engorged capillaries, with hærnorrhage into the spleen tissue,
blood-cells being seen amongst the spleen-cells. Engorged vessels are also seen in sonic
glomeruli, and a vessel distended with blood leading to the glomeruli ; further distended
vessels with hæœmorrhages around them are usually well marked under the capsule of the
spleen. Section of spleen stain well and the cells are distinct.
Kidney.—The vessels, both large and capillary, are distended with blood-cells at places,
vessels have ruptured and hæœmorrhage is seen into the kidney substance. This condition
is marked immediately beneath the capsule. Blood-cells are seen in many of the tubules,