38
[CHAP. II.
engorgement of the pelvis of the kidney with petechial hæmorrhages and sometimes a large
clot distending the pelvis and calices. The whole ureter was frequently engorged, and
distinct hæmorrhages could be seen under its inner coat. The bladder was usually distended
with urine, which was either of the normal or a slightly blood-stained colour ; small
hæmorrhages were frequently seen in the mucous membrane of the bladder.
The Genital System showed nothing abnormal beyond some engorgement,
The suprarenal capsule and thyroid body were engorged, but otherwise normal.
The Peritoneum showed considerable engorgement, and hæmorrhages into the retro-
peritoneal tissue were frequently found ; thus, they were seen on the under surface of the
diaphragm, on the upper surface of the liver, especially close to the ligaments, and in one
instance there was a hæmorrhage completely enclosing the gall-bladder, so that there was a
casing of coagulated blood between the peritoneum and gall-bladder. Similar hæmorrhages
behind the peritoneum were found on the surface of the spleen, kidneys, and intestines, and
sometimes large coagula in the retro-peritoneal tissue of the lumber region.
Circulatory System.—The pericardial cavity usually contained a few ounces of blood-
stained or clear fluid, and petechial hæmorrhages were constantly seen beneath the visceral
and parietal pericardium. The heart-muscle was either normal or in some cases rather soft
and friable ; considerable dilatation of the right side, with post- mortem clots in the cavities;
was often present. There was not much engorgement of the walls of arteries, but the vena
cava and other large veins showed this condition very markedly. On opening the veins
distinct petechial and larger hæmorrhages were seen under the inner coat, giving it a mottled
appearance. Where a large vein, e. g., axillary or femoral, was included in the bubo, this
hæmorrhage into its walls was constantly seen, so that the extravasated blood in the gland
itself, in the areolar tissue outside it and in the walls of the vein, was all directly continuous.
I think that the blood itself was rather more fluid and showed" less tendency to clot than is
usually seen after death.
The Respiratory System.—There was some engorgement of the larynx and trachea, and
the mucous membrane of the bronchial tubes was usually swollen and engorged, sometimes
greatly so. There was much general engorgement of the lungs with ædema, and small
hæmorrhages into the lung tissue were seen rather frequently. Frothy sero-mucous fluid
which was sometimes blood-tinged, was found in the bronchi. The pleura showed marked
engorgement, and its cavity often contained some blood-stained or clear fluid ; sub-pleural
hæmorrhages, sometimes of large extent, were commonly found on the upper surface of the
diaphragm, on the chest-wall, and on the surface of the lungs, especially between the lobes
In cases of cervical bubo the engorgement and ædema extended to the larynx, and œdeina
of the glottis was present.
Note.—A variety of the bubonic form of plague must be mentioned here ; for, instead
of finding one large bubo, such as has been described above, the following condition was
observed : A chain of enlarged glands was found in the inguinal region and it extended into
the pelvis right along the iliac artery as far as the lumber glands. These glands were dark-
red, soft and friable and intensely engorged, and looked like soft spleen tissue ; there was
great engorgement, extravasation, and œdema around them, and they surrounded the iliac
artery and vein, so that in dissecting out the gland mass these vessels came away enclosed
in it. The glands were as large as almonds or smaller, and were so incorporated in the
coagulated blood that it was scarcely possible to dissect them out. The remaining glands
and other organs in the body were in the condition described above.