35 



more fluid than usual, which was sometimes blood stained; and minute 

 hemorrhages were found in both its vesical and parietal portions. The 

 myocardium was generally soft with many muscle fibers undergoing granulo- 

 fatty degeneration : and the right ventricle was always dilated while in 

 many cases there was also dilation of the other cavities of the heart. The 

 walls of the larger vessels appeared normal, but those of the veins were 

 engorged, and minute and large hemorrhages were frequently observed 

 beneath the inner coat. Dr. Childe found that when a large vein was 

 included in a bubo, hemorrhage into its walls was constantly seen, so that 

 the extravasated blood in the gland itself, in the areolar tissue outside, 

 and in the walls of the vein was continuous. 



Respiratory system. — The larynx was in all cases affected and in a few 

 instances there was hemorrhage beneath its surface. In cases of cervical 

 bubo, (Edematous swelling involved the soft structures of the larynx and 

 the aryteno-epiglottidian folds. The bronchial tubes were also congested 

 and swollen, and in many cases contained blood-tinged frothy fluid; 

 but the trachea was merely congested. The lungs were engorged with blood 

 and with serous fluid; occasionally small hemorrhages were found in the 

 lung svibstance, and when the lungs were cut into much sero-sanguinous 

 fluid escaped. When pneumonia or broncho-pneumonia had occurred as a 

 complication, the pathological changes produced by these diseases were also 

 present. The pleural cavity contained blood-stained or clear fluid. Sub- 

 pleural hemorrhages, sometimes of large extent, were found on the parietal, 

 visceral and diaphragmetic pleura and occasionally there was evidence of 

 fibrinous inflammation. Hemorrhages were sometimes present in the 

 anterior and posterior mediastina. 



1^'ervous system. — -The dura and pia mater of the brain, as well as the 

 coverings of the spinal cord, were congested, and in a few instances extra- 

 vasations of the blood were found on the dura mater. The brain substance 

 and spinal cord generally presented a healthy appearance; but occasionally 

 congestions and oedema were present, which involved likewise the choroid 

 plexuses. No pathological change has been observed in the nerve trunks. 



Bones, joints. — It has further been noted that the marrow of the long 

 bones is red and congested as in other infectious fevers, and that evidence 

 of an infective inflammation is found in the fringe-like processes of the 

 synovial membrane of the knee joint. 



Intense or septiccemic type of plague. — In those cases in which the plague 

 virus or toxin is in the patient widespread from the beginning of the 

 illness, so as early to produce a general poisoning, whether septicemic 

 or toxsemic, the pathological changes, an might be expected, are much the 

 same as in the more severe cases of Pest is major. Some observers, however, 

 believe that pathological difl"erences occur to distinguish this form of 

 plague, and to serve, along with the symptoms, as a justification for the 

 establishment of a so-called septicaemic type of the disease. They consist 

 of the absence of buboes having the characters above described, and of a 

 widespread invoh'ement of glands, with ' distinctive changes in several of 

 them. Although the lymphatic glands are always aflFected, in place of the 

 affection consisting of one or, more rarely, of several groups of glands 



