2o 



emboli are found in a limited number of glomeruli only; nor an' 

 any tufts seen where all the capillaries are obliterated. The emt>olic 

 closure is generally confined to one lobe of a glomerulus. Some- 

 times the embolic bacterial mass extends into the afferent or efferent 

 vessel (it is impossible to decide which of the two is affected). 

 In tlie neighborhood of such thrombosed vessels there are small 

 microscopic areas of blood extravasation, in which few bacilli are 

 found. All the renal vessels are much engorged, particularlv the 

 small vessels, and the interstitial tissue is quite oedematous. Small 

 microscopic areas of blood extravasation are encountered all through 

 the sections. A few bacilli are often seen in such areas as well as 

 in the tubules, the lymph clefts, and even occasionally in the small 

 arteries and veins. The tubular epithelium shows profound cloudy 

 swelling and fatty degeneration. Hyaline fibrin thrombi are not 

 present in the renal tissue. 



GROUP VI. PRIMARY PLAGUE SEPTICAEMIA. 



Case Xo. 30. Primahy Plagle .Septic.i:mia. 



(Necropsy Protocol No. 983. L. T. T., Chinese, male, 28 years of age, from 211 

 Santo Cristo Street. San Nicolas. Ill for ten days. Died June 4, 1904, at 1 

 o'clock p. m. Postmortem examination made fifteen hours after death.) 



Anatomic diagnosis. — Congestion and oedema of tlie lungs; fatty degenera- 

 t ion of the liver ; acute parenchymatous nephritis ; multiple subserous and 

 -submucous hemorrhages (lungs, heart, kidneys, ureters, bladder, stomach, 

 intestines). Plague septicipuiia. 



Microscopic examination. — The histologic changes in the kidneys 

 are very profound. There is universal cloudy swelling and fatty 

 degeneration of the tubular epithelium. The tubules are generally 

 filled with granular detritus, and in many instances sharply outlined 

 hyaline casts are found. These hyaline masses are composed of a 

 homogeneous material (staining with eosin and somewhat with 

 methylene blue) ; however, this does not give the tinctorial fibrin 

 reaction. The glomerular cai)illari('s are generally not much 

 altered, but here and there a partial hyaline (fibrin) thrombosis 

 r-.m be seen. Occasionally one observes an intertubular thrombosed 

 vessel. Plague bacilli are found in small groups in some of the 

 glomeruli ; they are also observed both in the capillaries and between 

 them. A very few isolated organisms are encountered in the 

 interstitial connective tissue l)etween the tubules. 



