72 



Agar culture tubes inoculated during the post-mortem exam- 

 ination from the heart's blood, the liver, and the spleen developed 

 typical plague cultures. 



Microscopic examination. — Sections from the submental glands 

 of the right side show much enlarged and congested vessels, general 

 oedema, areas of blood extravasation, varying from the accumulation 

 of a few red blood corpuscles to extensive and widely spread 

 hemorrhagic areas. The finer structures of the gland are almost 

 completely obliterated and the cortex and medulla are indistin- 

 guishable. The gland cells are mostly of the usual mononuclear 

 type. Here and there plasma cells are found. Eosinophilic poly- 

 ■nuclears are very scanty. The vessel walls show little or no 

 change, appearing fairly normal even in the middle of areas of 

 extravasated blood. Hyaline thrombi are not found in the gland- 

 ular vessels. The whole of the tissue is densely infiltrated with 

 innumerable plague bacilli, which are characteristic in shape and 

 show polar staining. The capsule and the surrounding areolar 

 tissue are oedematous and infiltrated with blood. The whole peri- 

 glandular tissue is completely permeated by a cellular exudate. At 

 the hilum the vessels are enormously enlarged and the perivascular 

 tissue is increased and quite oedematous, so that the individual 

 connective fiber tissues are separated by wide diastases. In spite 

 of these profound changes, there is comparatively little advanced 

 coagulation necrosis and areas where the nuclei have lost their 

 staining properties are few and far between. In the spleen the 

 Malpighian corpuscles are generally distinct in outline, although 

 in some of them the boundaries have become indefinite. Here and 

 there one of the corpuscles shows a proliferating center with large 

 mononuclears, but without mitotic figures. The pulp spaces are 

 not distinct because of dense crowding with erythrocytes and 

 leucocytes. Among the latter there are seen small mononuclears, 

 ordinary polynuclears, and a considerable number of eosinophilic 

 pol}Tiuclears. There are also found fairly numerous large mono- 

 nuclears with large, round, vesicular nuclei and a protoplasm which 

 stains to some extent with methylene blue, though not as markedly 

 as the plasma cells. Some of these cells show two nuclei; they are 

 very probably proliferated endothelial cells. jSTone of them in 

 this case show phagoc3'tic properties. Numerous plague bacilli are 

 found in the pulp spaces, but very few, if any, in the corpuscles. 

 The thymus shows the normal lymphoid tissue with included con- 



