268 PUBLIC HEALTH BACTERIOLOGY 



Etiology and Pathology. Dr. R. P. Strong and Dr. Teague 

 performed twenty-five post-mortem examinations, and 

 came to the following conclusions : That epidemic plague 

 pneumonia results from inhalation, the primary point of 

 infection being the bronchi. Through the bronchi the 

 bacilli reach the lung tissue, and rapidly multiplying there 

 they produce pneumonic changes of the lobular type and 

 later more general lobar involvement. The blood becomes 

 quickly infected and a true bacteriaemia results in every 

 case. Secondary pathological changes occur, especially in 

 the spleen, bronchial glands, heart, blood-vessels, kidneys, 

 and liver. The fact that the bronchial glands at the 

 bifurcation of the trachea are always much more affected 

 than any of the other lymphatics, argues against the theory 

 that epidemic plague pneumonia is primarily a septicaemia 

 with secondary involvement of the lungs. Moreover, in 

 the earliest stages of the disease, the blood may be free of 

 plague bacilli. The condition observed in the trachea and 

 bronchi in epidemic plague pneumonia is pathognomic of 

 this condition alone. The throat and larynx may show 

 characteristic appearances at times. The tonsils may 

 become secondarily infected like other lymph follicles, but 

 the duration of the disease is too short to allow of this as a 

 rule. Primary infection by tonsil can occur, with enlarge- 

 ment of the glands of the neck early in the disease. The 

 oesophagus was found normal in every case, which argues 

 against primary intestinal plague infection, since plague 

 bacilli must have been repeatedly swallowed in sputum 

 and bronchial secretion in many of the cases. 



Dr. Koulecha, who had dissected twenty-eight plague 

 corpses, read a communication in which he differed in 

 toto from the above in regard to the mode of infection. 

 From the necropsies and microscopical examination of the 

 tissues he concludes that pneumonic plague is a septicaemic 

 disease, in which an overflooding of the blood and the 

 lymphatic system with bacilli could be observed. 

 Infectious matter entered the mouth, affecting en route 

 the tonsils, mucous membrane of the trachea, bronchi, 

 and neighbouring lymphatic glands ; and from these the 

 bacilli passed into the blood. The lungs were apparently 

 affected secondarily from the blood, which he inferred from 



