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A second form of the pest which they describe is the septicopyemic. 

 In it embolic foci are present in the lungs, the liver, and the kidneys. A 

 third one is the primary pest pneumonia, which is a confluent lobular 

 pneumonic process, usually attended with, noticeable lymphatic enlarge- 

 ment. The common portal of entrance of the bacilli is the skin, but only 

 exceptionally can the precise point of infection be discovered, the demon- 

 stration of the place and the mode being indicated by the location of the 

 primary bubo. A single instance of purulent meningitis, due to the pest 

 bacillus, was encountered by the Austrian Commission. The invasion of 

 the blood takes place always from the primary bubo or from the lungs, 

 as a primary blood infection does not exist. The primary bubo may be 

 so small that it cannot be discovered clinically and is found anatomically 

 only after careful and prolonged search. In foudroyante cases the formation 

 of a bubo may fail altogether. The primary bubo is distinguished by 

 destruction of the lymphatic parenchyma, necroses, and hemorrhages, and 

 (in the case of mixed pj'ogenic infections) by suppuration. A similar 

 condition is fovmd in the surrounding cellular tissue. Bacilli are present 

 in great numbers. The secondary buboes show, on the other hand, uniform 

 hyperemia, occasionally hemorrhages, and, in more protracted cases, 

 medullary swelling. The primary buboes of the second order approach 

 one or the other type, depending upon their distance from the gland 

 primarily affected. The multiple hemorrhages are not the result of the 

 action of toxines elaborated at a distance, but are caused directly by bacilli 

 which may always be found in the neighborhood. Parenchymatous and 

 fatty degeneration of the heart, the liver, and the kidneys occur commonly. 

 Splenic tumor is a constant occurrence. The spleen shows marked changes. 

 The pulp is distended with blood and contains many poly-morpho-nuclear 

 cells. The follicles are but little altered, but the trabeculse are swollen and 

 homogeneous. In some instances the endothelial cells of the pulp have 

 proliferated and desquamated. When very great numbers of bacilli are 

 present miliary necroses may occur. The bacilli are very abundant in the 

 pulp, more scanty in the follicles; sometimes they may be contained within 

 cells. In the pysemic form of the disease foci are formd in the liver, the 

 limgs, the kidneys, the spleen and the musculature. In about one-third 

 of all the cases of plague secondary pyococcal infection has taken place. 



The primary pneumonia appears in the form of a lobular consolidation, 

 which, when foci are numerous and confluent, may produce lobar solidifica- 

 tion. Bronchitis is present. The bronchial lymphatic glands present 

 appearances of primary, the others of secondary buboes. In addition to 

 the primary, two other forms of pest pneumonia are recognized, one 

 metastatic, which appears as multiple and larger foci, seated beneath 

 the pleura, the other as an aspiration pneumonia, from the aspiration of 

 infected material derived from buccal buboes. In plague pneumonia one 

 generally sees shining through the lungs, fine, yellow and red markings 

 or spots, which are produced by yellowish points or stripes on a red back- 

 ground. The picture resembles the one presented by plague lymph glands 

 rich in bacilli. In the lungs this appearance is produced by enormous 

 masses of bacilli contained in the alveoli. The cut surface shows a picture 



