21 



in order to explain and justify our opposition to the classification 

 of plague in man as a general hemorrhagic septicaemia. 



A study of the histopathology of plague suggests the following 

 pathologic classification into a number of groups, viz: 



(1) Primary uncomplicated bubonic plague. 



(3) Primary bubonic plague with secondary septico-pyemia. 



(3) Primary bubonic plague with secondary plague pneumonia. 



(4) Primary plague pneumonia. 



(5) Primary plague pneumonia with secondary septico-pyemia. 



(6) Primary plague septicemia. 



This classification does not, of course, include any secondary or 

 tertiary complications due to micro-organisms other than the plague 

 bacillus. We shall be able to illustrate all of these different types 

 by cases investigated. 



A number of writers have distinguished intestinal plague as 

 a special form of the disease. Wilm, for instance, believes that 

 the plague bacilli frequently enter the body of man through the 

 gastro-intestinal tract and thus lead to a type which is well charac- 

 terized both clinically and anatomically. Hossack says that 5 per 

 cent of the plague cases occurring in the Calcutta epidemic of 1900 

 were of the intestinal type, and that 3 per cent of those in the one 

 of 1896-97 were of a similar nature. Zupita reported a case 

 of intestinal plague, but from its description it clearly appears that 

 it was one of primary inguinal bubo, with primary buboes of the 

 second and third order in the pelvic and abdominal cavities. In 

 fact, we have failed to find in literature a single case which 

 anatomically could be clearly classified as a case of intestinal 

 plague. In our work special attention has been paid to this sub- 

 ject and every one of our cases in which a post-mortem examination 

 was made was carefully examined in order, if possible, to find a 

 primary bubo of the first order of the mesenteric or other intestinal 

 lymph glands. But none was encountered. It appears that up 

 to date the occurrence of intestinal plague in man has not been 

 proved beyond dispute. Even where rats have been fed on plague- 

 infected food, the disease is generally of the bubonic type (cervical 

 or submaxillary bubo) with simultaneous or secondary plague 

 septicaemia. 



Another type of the disease which has been grouped separately, 

 but which generally is not accepted as a type per se, is skin or 



