40 



fatty degeneration and necrosis of the liver and an enlarged spleen some- 

 times of good consistency, but more frequently soft and friable, were found 

 on post-mortem examination. The kidneys showed evidence of parenchy- 

 matous degeneration, sometimes with hemorrhagic foci; such were also 

 exceptionally seen in the bladder. The heart showed subepicardial hemor- 

 rhages; endocardial inflammation or valvular changes were not seen. Once 

 a meningitis and once a meningoencephalitis was observed. In all grave 

 forms of the disease the lower and posterior portions of the lungs were 

 found hypostatic. A pure case of primary plague pneumonia was not seen 

 at autopsy. 



Jennings, in his Manual of Plague, gives a summary of the pathology 

 and morbid anatomy of the disease, in which he states that discoloration, 

 distinct from post-mortem lividity, caused by small or large subcutaneous 

 blood extravasation is almost invariably present in difTerent situations. 

 Papules, vesicles, or pustules may exist, also scabs or unhealthy ulcers. 

 The skin over buboes may show a necrotic appearance, or necrosed patches 

 of skin or large sloughing ulcers may also be present. Diffuse swelling 

 around the buboes occasioned by infiltration is often observed. The 

 lymphatic vessels, except those associated -with the buboes, are seldom 

 involved; occasionally, however, a more extensive, widespread lymphangitis 

 may be present. The glands may simply be enlarged, congested, or engorged, 

 or they may show a profound hemorrhagic condition. The hemorrhages 

 are often extended into the periglandular tissue and they may infiltrate 

 the whole neighborhood. Glands distant from the bubo are generally 

 swollen, congested, and engorged. Plague bacilli are abundant in the pulp 

 of the affected glands, but generally disappear after marked softening or 

 true suppuration have appeared. In septicsemic plague the glands show 

 very moderate changes only. In the gastrointestinal tract congestion of 

 the mucosa and oedema of the visceral walls are generally observed, and 

 petechiae in the stomach and large intestines, and to a lesser extent in the 

 small intestines, also occasionally more extensive hemorrhages in the 

 submucous tissue of the stomach occur. The solitary and the agminated 

 glands are swollen and congested, but never ulcerated; the retroperitoneal 

 and mesenteric glands are generally in the same condition and often 

 hemorrhagic. The spleen is much enlarged and subcapsular hemorrhages 

 make the surface lumpy and uneven. The liver is increased in size and 

 engorged, and sometimes presents a nutmeg appearance; occasionally yellow 

 necrotic patches are found scattered throughout the organ. Petechiae are 

 common on the surface. The kidneys are generally intensely imbedded in 

 extravasated blood; petechiae are common on the surface, also in the 

 pelves and calices; sometimes coagula are found in the former. Glomeruli 

 are engorged, all the blood vessels distended and the epithelium of the 

 tubules generally in a state of parenchymatous degeneration. The genital 

 organs are generally vmaffected, but in cases in which abortion has occurred, 

 the subinvoluted uterus and the ovaries are engorged and cedematous. The 

 lungs are generally engorged. Frequently hemorrhages are found in the 

 lung substance or on the surface, scattered over the pleura, or in the 

 mediastina. When the lungs are primarily involved or secondary pneumonia 



