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dark brownish-red on the cut surface, and granular; much juice 

 can be scraped off. The trabeculae and Malpighian corpuscles 

 are fairly well marked. Kidneys: The right kidney is much 

 congested and dark purplish-blue; the cut surface shows injected 

 vessels and somewhat yellowish tubules. The mucosa of the 

 pelvis is injected and shows several hemorrhagic spots. The left 

 kidney is also much congested, but rather pale yellowish-gray on 

 the cut surface. The tubules are decidedly grayish-yellow and quite 

 dull in appearance. The pelvis is smooth and not markedly con- 

 gested. The ureters and the bladder are normal. The liver is 

 rather large with rounded margins and much yellowish mottling 

 alternating with bluish-purple areas. The cut surface is reddish- 

 brown and the vessels much injected. The mesenteric, retroperi- 

 toneal, bronchial, and other glands are all enlarged, congested, and 

 rather soft and juicy. There is nothing abnormal about the 

 intestines excepting a moderate swelling of the lymph follicles. 

 The serosa and the mucosa of the stomach are much injected; 

 there are no hemorrhages. 



Anatomic diagnosis. — Hemorrhagic lymphadenitis of the right 

 inguinal glands; multiple lymphadenitis with great congestion and 

 softening ; congestion of the kidneys and parenchymatous nephritis ; 

 fatty degeneration of the liver. Bubonic plague. 



Smears from the right inguinal glands show numerous plague 

 bacilli, those from the spleen only a moderate number. Tubes 

 inoculated from the glands developed a typical growth. 



Microscopic examination. — The right inguinal glands and those 

 of the chain which leads into the right iliac fossa show changes 

 resembling those in the other cases of hemorrhagic plague buboes. 

 The bacilli are present in very large numbers; however, solid 

 masses of them are found only in a limited area. In general, they 

 densely infiltrate the hemorrhagic and oedematous tissue. The tis- 

 sue elements of the infected glands in this case include a very 

 considerable number of mononuclears with a large body of proto- 

 plasm. The latter is hyaline and stains rather well with methylene 

 blue. A number of these large mononuclear cells contain bacilli 

 in their protoplasm, and the cells of this type are the only ones 

 which exhibit this phagocytic tendency. That the bacilli are 

 really inside the protoplasm and not on top of it can be seen in 

 very thin sections from oedematous areas where isolated cells can be 

 studied. Some of these mononuclears have engulfed other cells. 



