41 



supervenes, the walls of some of the alveoli are broken down by the 

 severity of the hemorrhages and patches of catarrhal inflammation, varying 

 in size, are scattered throughout the lungs. These patches are surrounded 

 by belts of engorged lung tissue. They may coalesce into larger patches. 

 Sometimes a whole lobe may thus be consolidated. The patches at first 

 are red and later on become gray; they are quite solid and do not float on 

 water. The air cells in the affected areas are filled with an accumulation 

 of epithelial elements, granular debris, cells resembling leucocytes, 

 intimately mixed into a gelatinous mass in which plague bacilli, often in 

 association with diplococci or streptococci, abound. The vessels in general 

 are dilated, the heart sometimes unaffected, more frequently soft, flabby 

 and friable. In all cases the right side of the heart is dilated and contains 

 post-mortem eoagula. 



A STUDY OF TWENTY CASES OF BUBONIC PLAGUE. 



The material which forms the basis of the original work of 

 this bulletin consists of twenty cases of plague occurring in Manila 

 and upon which autopsies were performed by the writer during 

 the period of time from February 19 to September 8, 1904. These 

 cases were without exception fully examined anatomically on the 

 post-mortem table, and also by cultural and histologic methods. In 

 the majority of the cases, in addition, animal experiments were per- 

 formed with the organisms isolated. One case which was not 

 completely studied has been included, because it showed the hyaline 

 fibrin thrombosis of the glomerular vessels which is so characteristic 

 in plague. ^ 



The histologic material was in all cases at the time of the autopsy 

 immediately fixed in Zenker's solution and was subsequently embed- 

 ded in paraffin and sectioned. In addition, in one case the material 

 was fixed in Flemming's solution. The stains employed in the 

 study of the sections were hematoxylin and eosin, eosin and 

 alkaline-metylene-blue, carmine and Weigert's fibrin stain, dilute 

 carbol-fuchsin and occasionally other stains. Dilute carbol-fuchsin, 

 which we found the most useful dye for smears from the organs, 

 is not very satisfactory in the treatment of sections, stained with 

 a view of studying the distribution of the plague bacillus, nor did 



* The number of cases upon which necropsies were performed during the 

 above-mentioned period of time has been in excess of twenty; but some of 

 them M-ere not considered in this report because of the greatly advanced 

 putrefactive changes, which excluded a satisfactory anatomic and histologic 

 examination, or on accovmt of the late hour in the day in which, for the 

 sake of an immediate diagnosis, the necropsy had to be hurriedly performed, 

 in consequence of which a careful anatomic study became impossible. 



