100 



adhesions. On the right side there is found an area of subpleural 

 hemorrhage^ which forms a direct continuation of the ones radiat- 

 ing from the axillary bubo. The lungs are in general normal in 

 form, fairly well inflated, and purplish-blue in color, with a few 

 small subpleural hemorrhages. The pulmonary tissues are con- 

 gested and oedematous. The mucous membrane of the trachea, the 

 bronchi, and the larynx is somewhat swollen and highly congested. 

 The heart is normal in size. The coronary vessels and their 

 branches are much engorged. A few subepicardial hemorrhages 

 are found on the anterior surface. The myocardium is rather soft 

 and flabby and pinkish-yellow in color. Otherwise the heart is 

 normal. The spleen is twice its normal size, quite soft, steel-gray 

 externally, and reddish-brown on section. The pulp is quite soft. 

 The trabeculse are well marked, the Malpighian bodies less so. The 

 liver is normal in size, though somewhat increased in consistency. 

 It is purplish-blue in color with some grayish-white mottlings. On 

 section it is found to be much congested. The gall bladder is 

 normal, containing a large amount of yellow, thin bile. The 

 kidneys are normal in size, smooth, bluish-purple externally, and 

 yellowish-pink on the cut surface. The pelves are much injected, 

 that of the left kidney containing a small amount of extravasated 

 blood. The adrenals are normal in size, of fair consistency, and 

 brownish-yellow in color. The mucosa of the stomach shows numer- 

 ous small hemorrhagic spots, which are also seen in moderate 

 numbers in the duodenal mucosa. The lymphatics of both the 

 large and the small intestine are somewhat swollen. 



Anatomic diagnosis. — Congestion and oedema of the lungs ; paren- 

 chymatous degeneration of the kidneys; right axillary hemorrhagic 

 bubo; general swelling, hypertrophy, and congestion of the lymph 

 glands. Bubonic plague. 



Smears made from the different organs show plague bacilli, 

 which are present in considerable numbers, together with some 

 diplococci in those from the axillary hemorrhagic bubo, and in 

 fair numbers in the left inguinal glands and in the liver, while 

 in the spleen they are plentiful. The cultures developed typical 

 plague bacilli, but all were contaminated. 



Microscopic examination. — The right axillary glands show an 

 almost complete necrosis with a loss of all the finer details of 

 structure and an intense hemorrhagic infiltration, which extends 

 into the surrounding tissue. A considerable number of very poorly 



