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bile. The mucous membrane is smooth. The serosa of the stomach 

 and intestines is injected. The superficial veins are marked as 

 reddish lines. The mucosa as a whole is moderately injected, with 

 punctiform hemorrhages in the ventricular portion. The intestinal 

 lymph follicles are somewhat swollen. The peritoneal covering of 

 the uterus and tubes is much injected. All of the fine super- 

 ficial vessels are visible in consequence of the marked congestion. 

 The cervical glands on both sides, including those along the sterno- 

 cleido-mastoid muscles and the deeper submental ones, are enlarged, 

 highly congested, and softened. On section a good deal of dark, 

 bloody fluid can be scraped from the surface. 



Anatomic diagnosis. — Hemorrhagic, acute, parenchymatous 

 nephritis; congestion and oedema of the lungs; moderate fatty 

 degeneration of the liver; hemorrhagic inflammation, hypertrophy, 

 and softening of the cervical glands on both sides ; more or less 

 general hypertrophy of most of the lymph glands. Bubonic plague. 



Smears from the cervical glands show numerous plague bacilli, 

 but those from the spleen only a moderate number. 



Before the body had been opened, three pediculi were picked up 

 from the scalp with sterile forceps and dropped first into an 

 empty sterile test tube and later into three fiasks containing 50 

 cubic centimeters of sterile, slightly alkaline bouillon. All of the 

 three flasks developed cultures of plague bacilli. The cultures 

 were then transferred to various media and the bacteria were 

 fully identified as typical plague organisms. One culture from the 

 spleen and two from the cervical glands likewise developed plague 

 bacilli. 



Since this child, dead of bubonic plague, had come from a dis- 

 trict which had been considered plague free for some time, inquiries 

 were made as to the possibility of the girl's having been infested 

 with pediculi from some one living in an infected district. Dr. 

 E. E. S. Newberne, district medical inspector, reported on the 

 matter as follows : 



So far as the records show, only two cases of bubonic plague, prior 

 to the one under discussion, have occurred on Calle Anda, the first in 

 1900 at No. 11, and the second in 1901 at No. 137. These numbers being 

 at a considerable distance from No 89, and in opposite directions, it may 

 be assumed that the district is not infected. The orphan, C. S., was taken 

 to 89 Anda from the Hospicio de San Juan December 24, 1903, and remained 

 in good health until the last days of February, when she became ill, 



