32 



and fever, frequently accompanied by collapse and vomiting. When the 

 bacteria have grown through the meshes of the lymphatic filter, they are 

 carried on by the lymph stream into the blood. The disease then becomes 

 septicsemic. 



(2) Distinguishable clinically though, from the point of view of the 

 pathologist, not sharply marked off from the secondary plague septi- 

 caemias just described, are the cases of plague commonly spoken of as 

 septicsemic, in contradistinction to bubonic cases. These are the cases 

 where, owing to the more rapid passage of bacteria through the lymphatic 

 filter, and possibly to a greater production of bacterial poisons, the 

 constitutional symptoms precede and overshadow the local symptoms, the 

 disease being in most cases rapidly fatal. 



(3) In the third form of plague, first bacteriologically established by 

 Captain Childe, I. M. S., plague bacilli invade the lungs and give rise 

 to pneumonia, death occurring in most cases within a few days after 

 the patient has been attacked. Owing to the absence of buboes, the 

 pneumonic form is often classed, along with the septicsemic form, in the 

 category of nonbubonic plague. 



(4) In addition to the three main types of plague which have been 

 described above, an abortive form of bubonic plague comes under observa- 

 tion. This is technically known as pestis minor, or pestis ambulans. It 

 can not be doubted that in these abortive bubonic cases the bacteria are, 

 as in the case of ordinary bubonic plague, carried to the lymphatic glands, 

 but they are held back there, the disease stopping short of the septicsemic 

 stage. In correspondence with this the constitutional symptoms are very 

 light. Indeed in certain cases not only the constitutional, but also the 

 local symptoms may be so slight as to be, except for their pathological 

 interest, almost undeserving of attention. Such cases appear to be ex- 

 tremely common among persons who have been much exposed to the 

 infection of plague and are characterized by sensations of numbness and 

 tingling, or by neuralgic pains, which in many cases are associated with 

 the development of spotty glands in the armpit and the groins. We may, 

 however, remark here that the w^hole question of pestis minor urgently 

 requires to be more fully elucidated. 



From very extensive data the Indian commission has compiled 

 the following summary of the pathology of plague : 



Caste and other prejudices of the natives, which were consistently 

 respected, have limited the number of post-mortem examinations relatively 

 to the large mortality from the plague in India. Descriptions of the 

 post-mortem appearances have, however, been laid before us, which together 

 amount to a considerable total, and are sufficient to clearly establish the 

 more important pathological features of plague. References may specially 

 be made to the reports of Dr. Choksy; Captain Childe, I. M. S.; Dr. Dyson 

 and Captain Calvert, I. M. S.; Captain Thomas, I. M. S., and Captain 

 Leuman, I. M. S., and to the evidence of several of these gentlemen and 

 also of Captain Wilkinson, I. M. S., Major Evans, I. M. S.. and Captain 

 Elphick, I. M. S. 



