27 



all vessels including alveolar capillaries, the alveoli are full of blood 

 and the hemorrhage is so intense that many of the alveolar septa are 

 broken down, entirely absent, or represented by mere shreds. Within 

 the circumference is seen a zone in which the alveoli are intact and are 

 completely filled with well-stained cells, so that there is no interval 

 between the alveolar wall and their contents, and in the center is one 

 universal mass of similar cells, and the cellular infiltration is so extreme 

 that the walls of the alveoli are scarcely visible. Such is the general 

 arrangement of the pneumonic patch, although there may be alveolar 

 hemorrhage in parts of either the middle or central zone. Under a higher 

 power the alveoli of the circumference are seen to be completely filled 

 with blood corpuscles, and a little fibrin or none at all, whilst the dense 

 central mass of cells consist of catarrhal epithelium and leucocytes with 

 some granular debris. Thus the pneumonic area has the appearance of 

 very extreme lobular or catarrhal pneumonia. The walls of the bronchial 

 tubes, as well as the large veins, show great engorgement and there are 

 hemorrhages into the vein walls. Blood and catarrhal cells may be seen 

 in the finer bronchi, but the bronchial mucous membrane is scarcely 

 altered, there being at most a little cellular proliferation. There are 

 the appearances of acute pleurisy over those pneumonic areas which 

 project upon the surface of the lung, with hemorrhages beneath the pleura. 

 The bronchial glands show engorgement of blood vessels, but in some 

 cases these conditions are only slightly marked and the glands looked 

 nearly normal. * * * 



"In cases of plague pneumonia the bacilli were seen in abundance in 

 the pneumonic areas; they could be found in pi'ofusion amongst the 

 catarrhal epithelial cells and leucocytes which filled the alveoli and 

 terminal bronchioles, as well as among the blood corpuscles of the alveoli 

 into which hemorrhages had occurred." 



Childe also describes a case of plague septicaemia with secondary deposits 

 in the liver, which in this particular instance was most peculiar; it was 

 slightly enlarged and congested, as in the early nutmeg condition, and was 

 stuffed throughout with small, yellow, rounded masses, varying in size 

 from a pin's head to a pea. They were rather soft and friable, but not 

 fluid, and there was no area of engorgement around them. They were found 

 both on the surface and throughout the whole substance of the liver. 

 They looked like necrotic foci and microscopically proved to consist of 

 dense masses of plague bacilli with necrotic cells surrounding them. 



It may here be mentioned that Bazaroff, working under the direction 

 of Roux, first produced plague pneumonia experimentally in animals by 

 introducing plague bacilli in their nasal cavities. The disease developed 

 by experiments is described as a lobular or confluent broncho-pneumonia 

 with secondary general septiciBmia. 



The German Commission distinguishes three types of plague: Bubonic 

 plague, plague pustule of the skin, and plague pneumonia. Whether an 

 intestinal form of plague exists the Commission is unable to decide; it 

 did not encounter a case in the human material examined, though it 

 succeeded in producing intestinal plague in rats and monkeys by feeding 



