37 



While, liowever, a catarrhal inflammation of lobular distribution has 

 most frequently been regarded as the characteristic type of primary plague 

 pneumonia, several observers have denied its existence, and have asserted 

 that croupous (lobar) pneumonia is the form which most frequently 

 occurs. Major Evans, I. M. S., and Captain Elphick considered that all 

 cases of typical plague pneumonia come under the latter category, and 

 Major Jones expresses the opinion that "lobar pneumonia is common." 

 Major Evans stated that the pneumonia is distributed in small patches, 

 constituting lobular areas, only when the inflammation has not advanced 

 far; but that it is lobular to the extent of involving a whole lobe or the 

 greater part of a lobe when the lung inflammation has advanced further. 

 Captain Elphick, I. M. S., described several autopsies in which individual 

 lobes or even an entire lung were consolidated, and he stated that "every 

 case of pneumonic plague examined showed lobar condensation." It may 

 further be stated that in many cases only slight changes were found in the 

 bronchi. It is therefore possible that the pneumonia is lobular in patients 

 who have died at an early stage of the disease, and lobar in those who have 

 survived to a later period; or, otherwise, that lobar pneumonia occurs 

 when the toxin is most virulent and most widely distributed throughout 

 the lung, and lobular pneumonia when it is less virulent and less widely 

 diffused. 



The microscopic examination has mainly shown general dilatation and 

 engorgement of the veins and smaller blood vessels and numerous capillary 

 and larger hemorrhages in almost every structure and organ of the body. 



Indian Plague Commission's summary of pathological conditions. — "The 

 distinctive pathological changes produced by the virus of plague would 

 therefore appear to consist of universal dilation and engorgement of veins 

 and smaller blood vessels, with hemorrhages, both minute and of large 

 amount, in nearly every part of the body, and of enlargement of the 

 lymphatic glands, with oedema and hemorrhage in the surrounding tissues, 

 generally mainly implicating the external glands, but occurring likewise 

 throughout the body and involving in a series of cases the entire system 

 of lymphatic glands. In the lymphatic glands, the characteristic conditions 

 are largely explainable by vascular changes, and even in the pneumonia of 

 plasrue. vascular dilatations and hemorrhagic extravasations give a special 

 character to the lung inflammation. In no other infective disease are these 

 features represented, but it is of some interest to note that the vascular 

 changes, and especially the prevailing and characteristic tendency to 

 extravasation of blood in almost every part of the body, are closely repro- 

 duced in toxaemia caused by the organic poison secreted by the venom 

 glands of several species of serpents such as the black snake {Pseudechis 

 porphyriacus) of Australia." 



Flexner, who examined six cases of plague in San Francisco, besides 

 giving a summary of the morbid anatomy, reports more fully on the 

 microscopic changes of the lymph-glands and of the spleen. He states 

 that in the primary bubo the separation into the medulla and cortex has 

 been effaced, that masses of lymphoid cells still exist but that they do not 

 compose typical structures. Remains of cell forms, nuclear fragments, 



