58 



are much congested and very soft. Externally they are dark bluish- 

 gray, with some subcapsular petechia and ecchymoses. On section 

 the vessels are greatly engorged, the tubules grayish-white, and the 

 surface as a whole dull. The mucosa of the pelvis and bladder is 

 greatly congested. The mucosa of the ureters and the bladder is 

 moderately congested, but shows no hemorrhages. The suprarenals 

 are large, swollen, soft, and dark yellowish-brown. The liver is 

 large, its margins rounded, its capsule thin and transparent, and its 

 external color a yellowish-bluish-purple, alternating with decidedly 

 grayish-yellow areas. Along the insertion of the suspensory liga- 

 ment are seen numerous subcapsular hemorrhages, varying in size 

 from a mere point to a diameter of 5 to 7 millimeters. The organ 

 is of much increased consistency, and the cut surface is brownish- 

 yellow in color. The gall bladder is distended with dark yellowish- 

 green bile. The serosa of the stomach and intestines shows a 

 number of hemorrhagic spots. The gastric mucosa is studded with 

 small hemorrhagic areas and so is that of the duodenum, though to 

 a lesser extent. The lymph follicles of the intestines are swollen. 



Anatomic diagnosis — Congestion of the lungs; congestion and 

 parenchymatous degeneration of the kidneys ; fatty degeneration of 

 the liver; multiple subserous and submucous hemorrhages; mul- 

 tiple hemorrhagic lymphadenitis. Bubonic plague. 



Smears from the right inguinal glands show innumerable typical 

 plague bacilli ; those from the spleen show numerous pest organisms. 

 Culture tubes inoculated from the inguinal glands and the spleen 

 developed a typical growth. 



Microscopic examination. — The inguinal glands show an enor- 

 mous dilatation and engorgement of the blood vessels, a moderate 

 degree of free blood extravasation, and marked oedema. A number 

 of the smaller blood vessels are completely obliterated by hyaline 

 thrombi. Other larger vessels show closely packed blood corpus- 

 cles and a network of fibrin between the corpuscles. The number 

 of leucocytes in the engorged blood vessels, including those which 

 show a network of fibrin, is very moderate. If at all increased over 

 the normal, they are not very greatly so. Any damage to the 

 vessel walls, which are much dilated, is not demonstrable, and 

 the vascular endothelium appears' intact. The cellular elements 

 of the gland are the same as in the other cases described above. 

 Plague bacilli are very numerous. However, they do not form 

 dense, almost solid masses, but infiltrate the intercellular spaces 



