202 CLINICAL BACTERIOLOGY. 



Portals of Infection for, and Mode of Distribution of, 

 Plague-bacilli. The plague-bacillus gains entrance into the 

 human organism most frequently by way of slight injuries, 

 scratch-wounds, etc. Infection through the skin may take 

 place simultaneously at several different points of the body in 

 the same case ; it has not yet been decided whether it can 

 occur through the intermediation of insects. The related 

 lymph-glands nearest to the portal of infection become 

 swollen, most frequently those of the inguinal and axillary 

 regions (primary plague-boils). Sometimes the glands of 

 the first degree remain free or are but slightly irritated, and 

 only those of the second and third degrees are seriously 

 affected. Sometimes the entire chain of glands from the 

 nearest to the most remote are intensely inflamed. At the 

 site of infection a pustule or a carbuncle is not rarely found, 

 and between this and the related lymphatic enlargement 

 frequently a distinct lymphangitis can be traced. In the 

 milder cases the buboes disappear. If, however, the gland- 

 filter is broken through, the plague-bacilli gain entrance 

 through the glands into the blood and the internal organs, 

 and the condition of plague-septicemia, which almost always 

 terminates fatally, is established. If the buboes undergo 

 suppuration, the plague-bacilli usually die quickly. Some- 

 times, however, secondary infection with streptococci is 

 superadded, and this then constitutes a serious menace to 

 the patient. In the septicemic form of the disease the bacilli 

 gain entrance into the feces and the urine in consequence of 

 the hemorrhages that occur so frequently. 



A second and less common portal of infection is consti- 

 tuted by the lungs. Bronchopneumonic foci occur, in 

 which the exciting agents of plague are found in pure cul- 

 ture or in association with diplococci and streptococci. ' The 

 sputum of such patients contains the plague-bacillus. 

 Finally, cases of primary infection through the tonsils 

 have . been observed, rapidly giving rise to general infec- 

 tion. 



The German Commission that went to Bombay in the 

 beginning of the year 1897 for the study of plague, and 

 from whose report the foregoing statements are taken, em- 

 phasized that the incredible filth amid which the natives 

 live, their crowding together in small dwellings, the frequent 

 small injuries, especially of the bare feet, the constant 

 scratching induced by vermin, are quite sufficient to explain 



