44 



wall. Midway between tlie larger and the lesser curvature a 

 number of hemorrhagic spots have become confluent. The hemor- 

 rhagic spots can not be wiped oS. The lower part of the esophageal 

 mucosa is likewise much congested. The serosa of both the small 

 and the large intestine is congested and dull. The mucosa shows 

 hemorrhagic spots, particularly in the duodenum. The follicles 

 are swollen. Several Ascaris lumbricoides were found in the 

 esophagus. The capsule of the liver is smooth and transparent, 

 the external color is ochre-yellow, the cut surface is fairly smooth 

 and yellow to light brown. The lobules are not enlarged; the 

 connective tissue does not appear increased. The veins contain 

 much blood. The organ, as a whole, is small and peculiarly formed ; 

 the left lobe forms merely a small appendix to the right one. The 

 weight is 1,210 grams. The length of the longest transverse 

 diameter is 20 centimeters, the sagittal diameter (antero-posteriorly) 

 9 centimeters, the thickness from above downwards is 12 centi- 

 meters. The left lobe measures 3 centimeters from side to side, 9 

 centimeters from before backwards, and is 2 centimeters thick. 

 When an incison is made over the left inguinal bubo, it is found 

 that the skin is completely adherent to the subcutaneous tissue, 

 fascia, etc. There first escapes quite a quantity of yellow, blood- 

 tinged serum, and the tissue beneath the skin presents a condition 

 of complete hemorrhagic infiltration. The glands have become 

 confluent, their capsules, except that of one, being indistinguish- 

 able from one another. The hemorrhagic infiltration and the 

 oedema extend into the inguinal canal. In the left half of the pelvis 

 the tissues are very oedematous, the loose areolar tissue is yellowish 

 and almost gelatinous; and imbedded in this tissue are swollen, 

 softened, hemorrhagic lymph glands. The iliac glands are in the 

 same condition ; the retroperitoneal glands at the bifurcation of the 

 aorta into the common iliac arteries, and even the ones farther 

 up along the abdominal aorta, likewise present a similar appearance. 



Smears made from the inguinal glands and from the spleen show 

 very numerous plague bacilli. The organisms are most abundant 

 in the glands. 



Anatomical diagnosis. — Hypertrophy of the heart; congestion 

 and fatty degeneration of the kidneys; fatty infiltration and 

 degeneration of the liver; hemorrhagic inflammation and hyper- 

 trophy of the left inguinal, femoral, iliac, and retroperitoneal 

 glands ; hypertrophy, softening, and congestion of the lymph glands 



