108 



as in the lungs and liver. Bacilli are seen but sparingly in the 

 sections. Kidneys: Sections of the renal tissues show practically 

 normal glomeruli, moderate parenchymatous changes in the tubular 

 epithelium, and highly congested vessels. 



The noteworthy features of this case are its ambulatory nature, 

 its sudden termination by embolism of the pulmonary artery, and its 

 complication with what undoubtedly appears to be a very recent 

 tuberculosis. According to Scheube tuberculosis is a very grave 

 complication of plague; and Pearse likewise considers it a very 

 unfavorable factor in this disease. It is very probable that in the 

 case reported the plague virus first gained entrance through the 

 skin lesions of the legs into the inguinal glands, where only a 

 moderate multiplication occurred. The bacilli were then trans- 

 ported in the shape of a metastatic embolism into the lungs, from 

 where the embolish grew until it obliterated the pulmonary artery. 

 During the time these pathologic processes were going on, the 

 symptoms were so mild that the plague-infected patient never 

 stopped his regular work nor felt called upon to consult a physician. 



GROUP IV. PRIMARY UNCOMPLICATED PLAGUE 



PNEUMONIA. 



Case No. 17. Primary Uncomplicated Plagiie Pneumonia. 



[Necropsy Protocol No. 970. A. Q., Chinese, male, 30 years old, a shopkeeper 

 from No. 67 Tetuan, Santa Cruz. Sick six days ; died May 18, 1904, at 10.30 

 p. m. Post-mortem examination made thirteen hours after death.] 



The body of a well-developed Chinese about 30 years of age. 

 Post-mortem rigidity moderately marked ; post-mortem lividity well 

 marked, extending to the anterior surfaces of the body. The skin 

 as a whole is markedly cyanotic. The right axillary glands are 

 slightly palpable; the other superficial ones are not. There are 

 no injuries, wounds, or abrasions of the integument. On section, 

 a moderate amount of dark, fluid blood escapes from the veins. 

 The muscles are fairly moist and of a dark red (smoked meat) 

 color. The serous membranes are injected and rather dull. The 

 pericardium is much injected and contains a slightly increased 

 amount of a yellowish somewhat turbid fluid. The heart is 

 normal in size, the left ventricle contracted, and the right one 

 dilated. At the sulcus a number of subepicardial hemorrhages are 

 seen, the largest of which is about 0.5 to 0.6 centimeter in diameter. 

 Both sides contain gelatinous post-mortem clots. The valves, the 



