29 



of lung tissue and pi'ofuse hemorrhages might have occurred at any 

 moment. The bronchial glands, in some cases of plague pneumonia, 

 appeared like the external primary buboes, while in other ones, more 

 extensive changes were lacking. Besides the primary lesion one regularly 

 finds in plague cases, even in those which have died in the second or third 

 week from complicating affections, blood extravasations into the various 

 internal organs. Rarely have such hemorrhages taken place into the skin, 

 the subcutaneous connective tissue, or into the muscles. However, petechise 

 in the mucosa of the intestinal tract, frequently confined to the fundus 

 of the stomach and to the cecum, are often found. These hemorrhages 

 usually vary from the size of a mere point to that of a lentil, or sometimes 

 they may even be larger. They often have become confluent stripes, and 

 appear as such on the mucosal folds. In a few cases such punctiform 

 or linear hemorrhages are seen from the pharynx to the anus. Where old 

 ulcerative processes are present the hemorrhages frequently appear around 

 such lesions. One finds petechiae regularly in the pelvis of the kidneys, 

 more rarely in the renal capsules, in the gall bladder, in the serous 

 membranes of the heart, the lungs, the liver, etc. The lungs, the testicles, 

 the sheath of the nerves, the dura, the uterine mucosa, the placenta, are 

 in some cases the seat of more extensive hemorrhages, even if far distant 

 from the seat of the primary bubo. 



All these hemorrhages are not the direct effect of the bacteria, but more 

 probably the consequence of intoxication. In proof of this view the Com- 

 mission reports that it obtained three fetvises from plague patients. All 

 three presented numerous hemorrhages but were found absolutely germ 

 free. The Commission further states that it generally found marked 

 parenchymatous degeneration in the internal organs, generally enlargement 

 of the spleen and swelling and hyperemia of the lymph glands aside from 

 those affected by profound hemorrhagic infiltration. 



The German commission does not report any microscopic exam- 

 ination of tissues from plague cases. 



Albrecht and Gohn,^ of the Austrian Plague Commission, have introduced 

 the terms primary and secondary buboes. Primary buboes, according to 

 them, are those which are formed by the introduction and the extension 

 of the micro-organisms along the lymph channels, while a secondary bubo 

 is always the result of the propagation of the virus by the blood current. 

 The chief form of plague is denominated by them "septicsemic hemorrhagic." 

 It is characterized by a primary bubo, located most frequently in the 

 inguinal, axillary and cervical regions, about which there occurs a hemor- 

 rhagic oedema, and at greater distance hemorrhages into the organs. The 

 spleen is swollen, the general lymph glands are enlarged, and the paren- 

 chymatous organs show degenerative changes. The primary bubo may be 

 entirely lacking, the swelling of the lymph glands may be inconspicous, 

 and the hemorrhage may be the only pronounced sign. 



^Albrecht and Gohn's original report has not been accessible, and we 

 therefore quote mostly from Musehold, Flexner, and others who have 

 freely referred to the work of the Austrian commission. 



