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cutaneous plague. In our material we have not seen an example 

 of this type, and it may be mentioned that cases classed as cutaneous 

 plague have generally only been observed clinically and not studied 

 post-mortem. 



Musehold, in reviewing the literature on cutaneous plague, says : 



The term cutaneous plague applies to those cases in which there exists 

 at the beginning a (primary) plague vesicle, pustule, or carbuncle without 

 marked involvement of the lymph glands. If in the further development of 

 the disease the skin lesion does not spread, but the neighboring glands 

 become more prominently involved, then it would be better to speak of 

 cutaneous and bubonic plague, or still more preferably of bubonic plague 

 with primary skin lesion. 



The German Plague Commission among its clinical material had 

 fourteen cases of cutaneous plague, all of which, however, were 

 complicated by buboes; and the Austrian Commission likewise saw 

 no case of this form without typical buboes. Only Kitasato has 

 mentioned one case of primary plague carbuncle without buboes 

 but with septicsemia. From these data it would appear that a 

 separation into a group of those plague cases which show a marked 

 reaction at the cutaneous portal of entrance of the virus is hardly 

 justifiable and somewhat arbitrary. The extensive report of the 

 Indian Plague Commission does not recognize a distinct cutaneous 

 form of the disease. 



Another type mentioned by writers is ambulatory plague or 

 pestis minor. While such a group is admissible from a clinical 

 standpoint, it has no proper place in a classification based strictly 

 upon the pathology of the infection. Under pestis minor are classed 

 those mild cases in which a swelling of some of the external 

 l}Tnphatics is generally observed, but in which there are no urgent 

 clinical symptoms, and in which, in fact, a correct diagnosis may 

 be arrived at only after more serious cases have made their appear- 

 ance. These cases properly belong to the bubonic type. Our 

 knowledge of them, even from a clinical standpoint, is very meager ; 

 from a pathologic one it is practically nil. While every case of 

 pestis minor is ambulatory, every case of ambulatory plague is 

 not necessarily one of pestis minor. Indeed we can report such a 

 one in which the individual died very suddenly and where on 

 post-mortem examination such profound plague lesions were found, 

 quite aside from its fatal termination, as to remove it from the 

 group of pestis minor. 



