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per residuum temporis cum febre etiam continua et apostematibus et 

 anthracibus in exterioribus, potissime in subasellis et inguinibus. Et 

 moriebantur infra quinque dies. Et fuit tante contagiositatis, specialiter 

 quae fuit cum sputo sanguinis, quod non solum morando, sed etiam 

 inspiciendo unus recipiebat ab alio." (Haeser: Lehrbucli der Geschichte 

 der Medicin, 3 Aufl., lena, 1882.) 



Childe gives the following description of the first case in which he 

 made a post-mortem examination : "The lungs showed much general 

 engorgement and oedema, with sero-sanguinous frothy fluid in the bronchi, 

 but no pus; the usual appearances of acute bronchitis were absent. There 

 was one small pneumonic patch the size of a walnut, in the early second 

 stage, situated below the apex on the front of the right lung, and two 

 similar bvit smaller patches at the same part of the left lung. These patches 

 stood out a little from the surface, and were airless, friable, sank in water, 

 each was surrounded by a dark ring of engorgement, which merged into the 

 healthy lung, and there was recent pleurisy over the pneumonic areas. 

 All the other organs were examined and showed considerable engorgement, 

 but no special lesion was observed. The cervical, the axillary, and the 

 lumbar lymphatic glands were slightly enlarged. The left illiac slightly 

 enlarged, red, and soft; all the other glands, including the bronchial, 

 looked absolutely normal. Cultures made from the pneumonic lungs and 

 spleen developed plague bacilli." Childe, in the same article, reports the 

 clinical features of two cases of pneumonic plague — those of a physician 

 and of his nurse — and then says: 



"This form of plague is highly infectious, and probably has a large share 

 in the spread of the disease, for in these cases the patient's . sputum is 

 practically a pure culture of the plague bacillus, and, as there is reason 

 to believe that many of the cases are not recognized as plague at all, 

 precautions are not taken by the patient's friends and the dangerous nature 

 of the disease is not appreciated. I have no means of knowing how frequent 

 this variety of plague has been in the present epidemic, but there is some 

 evidence to show that a considerable number of cases have occurred. 

 * * * With regard to the literature on this subject, I have not been 

 able to find a published description of this variety of plague, but an allusion 

 is made in the accounts of the Pali epidemic of 1836, and it is stated that 

 the Astrakhan outbreak of 1877 was first regarded as croupous pneumonia 

 or as typhus complicated by pneumonia. From the reports on the Hong- 

 kong epidemic it appears that plague pneumonia did not occur there. 

 There is just this to add: The usual definition of plague in works of 

 medicine is: 'A specific fever, attended by bubo of the inguinal or other 

 gland,' but it seems that such a form of words does not include all varieties 

 of the disease." 



In a later contribution on the pathology of plague Childe also takes 

 up that of the common bubonic type, and states that the glandular 

 lesion is chiefly at the site of the bubo and there are but slight lesions 

 of the lymphatic glands throughout the body, but there are foimd 

 engorgement or petechise, or hemorrhages in nearly all viscera, notably 

 in the alimentary canal, especially the stomach and large intestine, 



