38 



shadows of red blood corpuscles, and plugs of finely granular structure 

 are seen filling spaces which suggest preformed vessels. Hemorrhages 

 exist in the medullary and cortical parts. The bloodvessels are commonly 

 thrombosed. The thrombi consist of cells, both mononuclear and polynu- 

 clear and fibrin. The walls of the smaller vessels often are hyaline and 

 structureless. Fibrin stain shows a fine network of fibrin about the 

 vascular walls, occurring partly within the lumen, partly within the wall, 

 and partly beyond in the perivascular tissues. Larger vessels show instead 

 of the fibrinoid transformation of their walls, destructive and infiltrative 

 changes. The intimal and medial coats contain an increase of cells and 

 many cell fragments. This infiltrative condition is especially marked in 

 the midddle coat. That many of these cells are polymorphonuclear is 

 shown by the bizarre forms and the staining properties of the nuclei. The 

 periglandular structures are extensively infiltrated and usually show 

 necrosis as well. The infiltration is partly cellular, partly fluid, along 

 with which fibrin is perhaps invariably present. The oedema and fibrin 

 are found chiefly in the coarse fibrous septa of the adipose tissue; the 

 cells occupj- the meshes of the fat cells. Bacilli are abundant in count- 

 less numbers within the swollen glands and in the periglandular tissues. 

 They occur in continuous growth throughout the glands, occupying every 

 available space; they completely occlude many blood vessels or, mixed 

 with definite thrombi, compose a considerable part of the plugs. Moreover 

 the walls of the blood vessels contain masses of bacilli having grown 

 within the vasa vasorum and the lymph spaces. The adventitial coats of 

 veins and arteries are especially rich in such growth of bacilli. In the 

 primary buboes of the second order the changes are all much less advanced 

 and marked. 



In a case of tonsilar infection changes similar to those described in 

 the primary bubo of the first order were observed. The presence of cells 

 resembling plasma cells is mentioned and many of these were observed to 

 be phagocytic. The spleen, in Flexner's six cases, was found moderately 

 enlarged, somewhat diminished in consistencv, color deeper than normal. 

 The pulp is described by the author as swollen, the swelling being the 

 result of cellular proliferation, cellular infiltration, and cedema. The 

 proliferation especially affects cells closely united with the veins and 

 surrounding the trabecular. These cells have reticulated nuclei, placed 

 excentrically, and a fair allotment of protoplasm, taking the blue thionin 

 stain. The cells are often polyhedral rather than roimd. They have a 

 close affinity to plasma cells. The lymphoid cells are increased, but to a 

 less extent than the cells just described. The vascular and other spaces 

 in the pulp contain an increased number of red corpuscles. In the same 

 spaces occur large cells of two kinds. One is a giant cell with single, 

 lightly staining, reticulated nucleus and a moderate amount of protoplasm, 

 and resembling the large, mononuclear, marrow cell with which it is 

 probably identical; it is not phagocytic. The other is a much smaller 

 cell, three to four times as large as the marrow cells and is highly 

 phagocytic. 



