31 



similar to that seen on the pleural surface; much viscid exudate can be 

 scraped from the surface. The plague foci in the lungs are surrounded by 

 a hemorrhagic ring in an oedematous area. The alveolar septa are broad- 

 ened. Microscopically they consist of a tissue which stains well with eosin, 

 and which contains a few cells or cell nuclei or red blood corpuscles. 

 The finer changes in the lymph glands, according to Albrecht and Gohn, 

 consist in necrosis of the vessel walls and in a very peculiar coagulation of 

 blood constituents. The more resistant vessels are generally enlarged, 

 their walls somewhat thickened. They are either uniformly thickened and 

 homogeneous or more frequently composed of solid bands of fibers which 

 stain deeply with eosin. In the interior of a vessel with such changed 

 walls, one finds a similar reticulum, sometimes consisting of fine filaments, 

 sometimes containing irregular masses or lumps. Threads penetrating 

 the vessel walls are in connection with the threads in the interior. The 

 picture reminds Albrecht and Gohn of the coagulation necrosis observed 

 in the epithelial layers of a diphtheritic membrane. Fibrin, however, is 

 either not found at all or else sparingly. 



Wysokowitz and Zabolotny, members of the Russian Plague Commission, 

 studied the disease in Bombay; they made twenty-seven autopsies and 

 most of their cases were those of bubonic plague. Six were of the primary 

 plague pneumonic form. In the bubonic cases they also found all the 

 other glands more or less swollen; however, these were less afi^ected than 

 the primary bubo, which was generally found to be very hemorrhagic. 

 Plague pneumonia is classified by them as a bronchopneumonia, with 

 a tendency of the foci to become confluent in the more protracted cases. 

 A whole lobe was never found involved in the pneumonic process. Hemor- 

 rhages in the gastric and intestinal mucosa were present in many cases 

 of all types, and the mesenteric glands were usually enlarged; in one 

 case the liver showed necrotic foci. The Russian authors, neither in their 

 clinical nor in their post-mortem researches, saw a case which would suggest 

 the intestines as the portal of entrance of the plague virus. 



The Anglo-Indian Plague Commission, whose medical members 

 were Fraser and Wright, has published in five volumes the most 

 extensive report on the great modern plague epidemic of India. 

 It divides plague into four types, namely, (1) bubonic, (2) sep- 

 ticsemic, (3) pneumonic, and (4) pestis minor or ambulans, and 

 elaborates upon the classification as follows (Vol. V., p. 53) : 



( 1 ) Plague, in its most typical variety, takes the form of bubonic 

 plague. In this form of plague the bacteria are carried by the lymph 

 stream into the lymphatic glands, in particular into the lymphatic glands 

 of the groin and the axilla — less frequently into those of the neck. The 

 bacteria multiply there, and excite a considerable amount of swelling 

 and inflammation, which manifest themselves in the form of a bubo. 

 The development of this bubo is often associated with severe pain. 

 Following closely upon — more rarely preceding — -the development of the 

 bubo, constitutional symptoms set in. They consist in malaise, headache. 



