39 



Tlie macrophages eiiglobe white cells — both mononuclear and poly- 

 nuclear — but rarely red blood corpuscles. They occur at times within the 

 larger veins, especially such as exhibit the subintimal cellular proliferation 

 to be described. The polymorphonuclear cells in the pulp exhibit great 

 variation in form and many would seem to have been in a state of active 

 migration when the tissue was fixed. They show great variety of form, 

 such as is seen in actively motile cells, and they would seem to be 

 moving in numbers in the pulp. Fibrin is found among the pulp cells 

 and in the fluid, and many bacilli are present. 



The Malpighian bodies are increased in size, this being due to the 

 multiplication of the lymphoid cells, and, to smaller extent, of epithelioid 

 cells. The latter do not occupy the centers of the nodes, but are few in 

 numbers and placed peripherally. Their nuclei are large and vesicular, 

 rarely a cell contains two nuclei. Degeneration of cells is uncommon, very 

 few fragmented ones being visible. Rarely small islands of fibrin are 

 present in the nodules. 



The blood vessels show two kinds of change. The arteries, chiefly those 

 of the Malpighian bodies, have hyaline walls; the veins of all sizes fre- 

 quently show subintimal cellular proliferation. The cells in the intima 

 are mononuclear and more rarely poljniuclear elements that form a 

 continuous, although not uniform, investment or appear as isolated pro- 

 jections into the lumen of the vessel. Above these cells the displaced 

 endothelial cells can usually be detected. Bacilli are very numerous, 

 especially in the pulp. They also completely occlude small blood vessels, 

 and within the trabeculte, probably lymphatics. However, since the richest 

 growths of bacilli are often unassociated with reactions, it is highly 

 probable that they may have taken place post-mortem. 



Calmette and Salimbeni made observations on plague during the last 

 Oporto, Portugal, epidemic, and they describe the macroscopic and some 

 microscopic lesions as follows : The buboes may be single or multiple, in 

 most cases they were multiple. They consist of one or more glands of 

 the same region. The former are increased in size in consequence of a 

 hemorrhagic inflammation which extends into the periglandular tissue and 

 sometimes into the overlying skin, producing phlyctense which may contain 

 plague and other bacteria. Microscopically one finds cellular debris, 

 masses of chromatin, few leucocytes, and many plague bacilli. In the 

 most profound rapidly fatal cases there are extensive hemorrhages, however, 

 when, death is delayed and is brought about by complications, one finds 

 that the contents of the bubo are true purulent material with few plague 

 bacilli. The authors also described the so-called cutaneous plague type, 

 of which, however, they saw very little in Oporto. Once they observed a 

 case which began as an oedeniatous, very intense inflammation of the skin 

 of the hand and the forearm and progressed to dark discoloration and 

 necrosis. In all three cutaneous cases which were observed a bubo developed 

 in the neighborhood of the superficial plague lesion. Skin lesions in the 

 shape of petechiae, ecchymoses, pustules, and hemorrhagic vesicles were also 

 observed in typical primary bubonic plague. The two authors observed a 

 case which resembled hemorrhagic smallpox. In the internal organs 

 congestion of the intestinal mucosa, swelling of the mesenteric glands, 



