no 



teric, the retroperitoneal, and the other superficial glands are all 

 moderately swollen and congested. On section their vessels are 

 found markedly engorged and their substance somewhat softened. 

 The most pronoimced enlargement is found in the axillary glands 

 of both sides. Smears from the consolidated areas of the left 

 lung show innumerable typical plague bacilli; those from the 

 glands and blood only a few. 



Anatomical diagnosis. — Parench3Tnatous degeneration of the 

 kidneys; fatty and parenchymatous degeneration of the liver; 

 multiple subserous and submucous hemorrhages ; lobular pneumonia 

 of the right lung. Plague pneumonia. 



Cultures inoculated from the consolidated areas of the right lung 

 developed a typical growth. 



Microscopic examination. — Lungs: The alveolar spaces in the 

 consolidated area are all more or less completely occluded. The 

 distended air sacs, filled with a completely granular detritus, 

 alternate in an irregular manner with the alveoli which are filled 

 with a cellular exudate. The interalveolar septa are generally 

 markedly broadened, however, this is not due to a marked increase 

 in the cellular elements but to an oedema and hydropic swelling of 

 the fibers and cells forming the interalveolar septa. The capillaries 

 are greatly engorged and the walls of the veins are oedematous, 

 loose, and frequently in a state of hyaline degeneration. Fibrin in 

 finer or coarses threads is quite extensively seen, both in the interior 

 of the alveoli and in the interalveolar tissue. The cellular exudate 

 in the air spaces consist mostly of pol3Tiuclears with some mononu- 

 clears and desquamated epithelial cells. Erythrocytes are present 

 ever}'where, but in moderate numbers. Plague bacilli are found 

 throughout the consolidated area, but not in very dense zoogloeal 

 masses, though in great numbers in some places. In the renal tissue 

 the most profound changes are cloudy swelling and fatty degenera- 

 tion of the epithelia lining the uriniferous tubules. The inter- 

 stitial tissue is quite oedematous, and the interstitial capillaries are 

 filled ad mamimum. The glomerular vessels are likewise engorged, 

 but otherwise do not show any profound changes. Xo plague bacilli 

 are found in the renal tissue. The liver shows small, interlobular, 

 inflammatory foci, composed mostly of mononuclear and embr\'onal 

 connective tissue cells and a few polynuclears. However, these 

 foci are quite small. The parenchyma cells show fine as well as 

 coarse vacuolation. The interlobular capillaries contain a good 



