18 



GROUP II. PRIMARY BUBONIC PLAGUE WITH SECONDARY 

 PLAGUE SEPTICO-PYEMIA. 



Case Xo. 17. Right Ixguixal Bubo with Secondary Plagie 

 Septicopyemia. 



(Necropsy Protocol XoT 1011. M. X., male Filipino, 40 years old, from 77 Sacristia 

 Street, San Nicolas. Ill six days ; died early July 29, 1904. Postmortem exami- 

 nation about six hours after death.) 



Anatomic diagnosis. — Congestion and oedema of the lungs; hemorrhagic, 

 acute, parenchymatous nephritis; parenchymatous and fatty degeneration 

 of the liver : hemorrhagic inflammation of the right inguinal and many 

 other lymph glands: extensive subserous, submucous, and interstitial hemor- 

 rhages. Bubonic plague; plague .septico-pyemia. 



Microscopic exainination. — All the renal vessels, including the 

 glomerular capillaries, are much dilated and engorged. Hyaline 

 fibrin thrombi are found in a few of the glomeruli. The throm- 

 bosis of the glomerulus is, as a rule, not complete and only a part 

 of the tuft is closed by fibrin. The thrombi are souietimes con- 

 tinued into the vasa afferentia and efferentia and beyond them. 

 A few thrombi are also present in the vasa recta of the medulla. 

 The capsular epithelium shows a minor degree of degenerative, but 

 no proliferative, change. Sections from the kidneys show an 

 extensive infection with plague bacilli, which is mostly localized 

 in the glomerular capillaries. Both in the open and in the throm- 

 bosed capillaries numerous bacilli may be seen in loose groups or 

 sometimes even in dense masses. In the thrombosed vessels the 

 bacilli are sometimes Ijetween the thrombus and the vessel wall. 

 The organisms occasionally extend beyond the glomerulus into the 

 vasa interloljulares. Here and there, bacilli are found at quite a 

 distance from a glomerulus and occasionally in the capsular space 

 and in the uriniferous tubules. 



Case Xo. 18. Left Femoral Hemorrhagic Bubo. 



(Necropsy Protocol No. 1127. G. P., male Chinese, 35 years old, from 182 Calle 

 Camba. Died March 6, 1905. Postmortem examination performed three hours 

 after death.) 



Anatomic diagnosis. — Left femoral hemorrhagic bubo; acute hemorrhagic 

 nephritis; fatty degeneration of the liver. Bubonic plague; plague septico- 

 pyemia. 



Microscopic examination. — The thrombosis of the glomerular 

 capillaries in this case is very extensive — in fact, it is found in every 

 glomerulus in the numerous sections examined. In general the 



