94 



are enormously congested. The brain substance shows many hemor- 

 rhagic points (small hyperemia vessels) ; otherwise no noteworthy 

 changes are seen. 



Anatomic diagnosis. — Congestion and parenchymatous degenera- 

 tion of the kidnej^s; congestion and oedema of the lungs; one 

 necrotic focus of the liver with congestion and fatty degeneration; 

 multiple subserous and submucous hemorrhages; left submental 

 hemorrhagic bubo. Bubonic plague. 



Smears from the deep hemorrhagic submental glands show many 

 typical plague bacilli; while those from the superficial, softened, 

 and congested glands reveal only a very moderate number. In 

 the juice of the spleen there are very few, and in that of the lungs 

 they are exceedingly scanty. Culture tubes inoculated from the 

 hemorrhagic glands and from the spleen developed a typical growth. 



Microscopic examination. — Sections from the deep submental 

 glands show a complete loss of the finer structure, extensive free 

 hemorrhages, and the formation of a homogeneous eosin-staining 

 material (evidently derived from degenerated blood corpuscles 

 which have become confluent, and extensive areas of necrotic 

 material. In the latter there are a few cells with pyknotic nuclei. 

 Vessels are still recognizable in this necrotic mass, but merely by 

 faint outlines, the greatly dilated walls having become much 

 thinned and loosened. The capsule has been loosened by a cellular 

 infiltration comjoosed of mononuclear and polynuclear leucocytes. 

 The infiltration extends beyond the capsule into the loose, periglan- 

 dular, areolar tissue. In the outer part of the gland, the cells 

 are better preserved and the hemorrhagic extravasation is moderate. 

 The cells found here, aside from erythrocytes, are mononuclears 

 and a few polynuclears. The former are mostly of the small type, 

 although there are some large ones, with a vesicular nucleus 

 containing a reticular chromatin and a large body which has a 

 marked afiinity for methylene blue. Bacilli are found irregularly 

 diffused throughout the gland; they are very poorly stained, shell- 

 like, and oval. The more superficial cervical glands are fairly well 

 preserved in structure, showing an increase of the hilum connective 

 tissue, great dilatation of the otherwise intact vessels, very small, 

 scanty areas of blood extravasation, and large mononuclears with 

 a somewhat basophilic protoplasm. Bacilli are present in very 

 scanty numbers. No fibrin thrombi or fibrin networks are found 

 in any of the glands. The spleen shows small, not well defined 



