. 33 



Pestis minor. — Death from Pestis minor probably never occurs, at any 

 rate, no description of the pathology of plague deals with this type. 



Pestis major, lymphatic si/stem. — (a) Buhoes. — The appearance of the 

 buboes was characteristic. As we have already stated, they varied much 

 in size and to a less extent in number. For the most part they consisted 

 of enlarged lymphatic glands surrounded by extravasated blood and serum, 

 which in many instances extended widely and deeply into the neighboring 

 areolar tissue, and often penetrated into the substance of the muscles. 

 Sometimes only one gland was included in a bubo, but more frequently 

 there were several, and at times an external bubo was directly connected 

 with one involving deeper seated neighboring glands, and when a femoral 

 bubo extended inwards so as to be continuous with one involving the 

 iliac glands. The swollen glands and the surrounding tissues were often 

 "matted together — so that it was difficult when once cut into it (the 

 bubo) to be quite sure which was gland and which was surrounding 

 tissue." The affected glands were round or oval in shape, and they 

 varied in size from that of a pea to that of a walnut. On section, they 

 were seen to be much engorged with blood, of a light red or deep purple 

 color, and of firm consistence in some cases, but soft and almost diffluent 

 in others. When the bubo was in the groin, the limb of the same side 

 was usually swollen and cedematous; when in the axilla, the serous 

 effusion and hemorrhagic exudation was sometimes so great as to form 

 a swelling involving the whole axilla and extending down the inner aspect 

 of the arm to the elbow, and do-\vn the side of the chest nearly to the 

 lowest ribs; and when in the neck a large swelling frequently resulted, 

 which pressed upon the larynx, trachea and cervical nerves and blood 

 vessels, and thus produced the dyspnoea which was so conspicuous a 

 symptom in those cases. As buboes in the groin and axilla frequently 

 pressed upon or surrounded the large blood vessels in these regions, 

 the oedema in the corresponding limbs is readily accounted for. 



It has been pointed out by Dr. Childe that in axillary buboes and 

 occasionally in chains of enlarged glands along the course of the iliac 

 artery and veins, the extravasated blood may be continuous with blood in 

 the interior of the veins, thus forming "a direct path for the passage of 

 the plague bacillus from the gland to the lumen of the vein, and so into 

 the general circulation." 



In a few cases of Pestis major, no pathological changes were found in 

 other lymphatic glands than those in connection with which buboes had 

 formed; but in most cases, many other glands, and especially the internal 

 glands, were affected. The changes in them, however, were relatively slight, 

 for they consisted only of enlargement, and of either moderate or great 

 congestion, a section of the gland in the latter instance showing much 

 engorgement with dark blood. In individual cases, many or few of the 

 glands were affected; but indeed no lymphatic gland, whether internal or 

 external, seemed to escape involvement, for these changes were observed 

 in various groupings, in the bronchial, mesenteric, peritoneal, iliac, lumbar, 

 trochlear, popliteal, and other glands. 



25483 3 



