86 



GROUP II. PRIMARY BUBONIC PLACUE WITH SECONDARY 

 PLAGUE SEPTICO-PYEMIA. 



Case No. 12. Right Ixguixal Bubo with Secondary Plague 



Septico-Pyemia. 



[Necropsy Protocol No. 1011. M. N., Filipino male, 40 years old, from 77 

 Sacristia Street, San Nicolas. Ill six days; died early July 29, 1904. 

 Post-mortem examination about six hours after death.] 



The body of a middle-aged man, about 40 to 45 years old, in a 

 fair state of nutrition, and strongly built. Post-mortem rigidity 

 strongly marked, as is also post-mortem lividity on dependent 

 parts. There are no wounds or abrasions. The right inguinal 

 glands are swollen. Here the tissues are hard, infiltrated, and 

 oedematous. Individual glands are not distinguishable. None of 

 the other lymph glands, with the exception of the left inguinal ones, 

 are palpable. Much dark, fluid blood escapes from the vessels 

 when the body is opened. All the serous membranes are highly 

 injected and reddened and numerous hemorrhages, to be more 

 fully described, are seen. The pericardium, aside from congestion, 

 is normal. The heart shows a number of subepicardial hemorrhages, 

 varying from one to several millimeters in diameter. The left 

 ventricle is well contracted and the right one dilated. The myo- 

 cardium is rather soft, pinkish-yellow, and dull in appearance. 

 Otherwise the heart is normal. The beginning of the aorta pre- 

 sents several raised, hard, atheromatous patches. The lungs are 

 heavy and externally are bluish-purple, with black patches and 

 subpleural hemorrhages. The right apex is adherent and con- 

 solidated, and at its very point there is an emphysematous . cystic 

 bladder of the size of a hazelnut with a smaller one of the size of 

 a pea. These vesicles contain air and collapse on being cut in to. 

 The apex as a whole is consolidated, and this area contains fibrous 

 and calcarepus nodules. The lungs, on section, are generally dark 

 brown and contain much blood and oedematous fluid. The bron- 

 chial, tracheal, and larjTigeal mucosa is moist, swollen, and deeply 

 injected. The epiglottis is uneven and dark red in color. The 

 papilla circumvallata of the tongue are much swollen. The spleen 

 is enlarged to from two to three times its normal size and is firm 

 in consistency. The capsule is smooth and steel-grayish-blue. The 

 cut surface is smooth and rather light brownish-red. The pulp is 

 not softened and does not protrude. The trabeculse are easily 

 visible: the Malpighian bodies are less so. The kidneys are normal 



