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injected, the tubules grayish-white, the pelvis smooth and slightly 

 injected, and the cut surface dull. The liver is very firm in 

 consistency. Its capsule is slightly uneven and finely nodular. 

 The external color is grayish-yellow. The organ is rather small, 

 and the left lobe in particular is flat and atrophic. The measure- 

 ments are 22 by 12 (high) by 13 (antero-posteriorly), right lobe; 

 the left lobe is only 2-2.5 centimeters thick. The weight is 1,595 

 grams. There is increased resistance on cutting the organ. The 

 color of the cut surface is ochre yellow. The acini are retracted, 

 and the boimdaries are well marked by an increase in the interlob- 

 ular connective tissue. The vessels discharge a moderate amount 

 of blood. The gall bladder is distended and contains a deep golden- 

 yellow turbid bile. Its walls are normal and its mucosa smooth. 

 The ducts are open. The mucosa of the stomach and duodenum 

 are moderately injected, the injection being most marked in the 

 gastric mucosa. There are no petechiae or ecchymoses. The uterus 

 is small and hard; the uterine mucosa is thin and atrophic. The 

 ovaries are small and nodular. There is no fresh corpus luteum. 

 Otherwise the genital organs are normal. None of the internal 

 lymph glands show marked changes. 



Anatomical diagnosis. — Splenomegaly (primary?) ; perisplen- 

 itis; cirrhosis of the liver with moderate fatty degeneration; con- 

 gestion and parenchymatous degeneration of the kidneys ; congestion 

 of both lungs; Banti's disease. Bubonic plague. 



After the completion of the post-mortem examination, it was 

 thought that this was not a case of plague but one of some other 

 infection which had taken a speedy fatal termination on account 

 of a complication with splenomelagy and hepatic cirrhosis. How- 

 ever, the examination of the smears made from the inguinal glands 

 revealed the presence of very numerous typical plague bacilli. 

 Few such organisms were found in spreads from the spleen, the 

 liver, and the lungs, while none were found in the heart's blood. 

 Cultures from the spleen and the lungs developed a plague growth. 

 No bacilli grew in the tube inoculated from the heart's blood. 



Tissues were taken from both lungs, the liver, the kidneys, the 

 spleen, and the heart, but none had been taken from the glands. 



Microscopic examination. — Spleen: The capsule is markedly 

 thickened, consisting of connective tissue fibers, spindle-shaped cells, 

 and occasionally an unstriped muscle fiber. An accumulation of 

 round mononuclear cells exists at the inner surface of the capsule. 



