61 



the size of a split bean. There the tissue is purplish-pink and the 

 swelling appears somewhat like an enlarged lymph gland. On 

 section this part seems somewhat tubercular, and one of the nodules 

 projects into the vesical mucosa. Otherwise the mucosa is smooth, 

 moderately congested. Prostate normal. Suprarenals swollen, soft, 

 yellowish-brown. Liver rather small. Capsule smooth, transparent, 

 much grayish-yellow mottling alternating with a pinkish-purple. 

 On section, veins moderately filled, cut surface slightly granular, 

 boundaries of acini distinct ; color ocher-light brown. Gall bladder 

 normal. Gastric duodenal and general intestinal serosa and mucosa 

 injected. Lymph follicles of small and large intestines somewhat 

 swollen. ]\Iesenteric, retroperitoneal, and other lymph glands 

 swollen and congested. 



Anatomical diagnosis. — Congestion of the lungs; congestion and 

 parench}Tnatous degeneration of the kidneys, splenomegaly, inter- 

 stitial hepatitis with fatty degeneration, hemorrhagic lymphadenitis 

 of the right inguinal glands. General hypertrophy and congestion 

 of lymph glands. Subserous and submucous hemorrhages. Bubonic 

 plague. 



Smears from the right inguinal glands show numerous, those 

 from the spleen a moderate number of plague bacilli. No Donovan- 

 Leishman bodies found in the splenic juice. The liver smears 

 exhibit a very few plague bacilli. The culture tubes inoculated 

 from the right inguinal glands and from the spleen developed 

 typical plague colonies. 



Microscopic examination. — Sections from the hemorrhagic areas 

 of the right inguinal glands show an abundant infiltration with 

 plague bacilli, particularly well pronounced in some peripheral 

 areas. Bacilli, while numerous, are not present anywhere to such 

 an extent as to form solid, clumped masses. Even where they are 

 most abundant there are a ie\v cells left between them. In general, 

 the histologic elements can be much better studied in sections of 

 this case than in those from glands which are simply choked by solid 

 colonies of the plague organism. The general characteristics of 

 the gland sections are a universal hemorrhagic infiltration with 

 marked oedema, increased diastases between the original parenchyma 

 cells, swelling of the fibrillar connective tissue reticulum, the 

 presence of numerous leucocytic elements, and geat dilatation and 

 engorgement of the vessels. Both in transverse and in longitudinal 

 sections of small veins, considerable damage to the vessel wall is 



