Ill 



deal of blood. The spleen shows no marked histologic changes^ 

 and only a veiy few bacilli are seen after a prolonged search. 

 Several lymph glands show marked dilatation and engorgement 

 of their blood vessels as well as some oedema; otherwise they are 

 fairly normal. The stomach exhibits greatly dilated vessels and 

 capillary hemorrhages between the glands and upon the surface of 

 the mucosa. No plague bacilli are found in the gastric areas of 

 blood extravasation. In fact, none of the organs except the lungs 

 contain any large number of these organisms. Outside the pulmon- 

 ary tissue they are practically not found at all. The necropsy 

 of this case shows it to be a pure plague pneumonia, without a 

 general septic or septico-pyemic dissemination of the bacilli. 



Case No. 18. Primary Uncomplicated Plague Pneumonia. 



[Necropsy Protocol No. 971. C. C, Chinese, male, 27 years old, from No. 67 

 Tetuan, Santa Cruz. Sick six days ; died May 18, 1904. Post-mortem exami- 

 nation fourteen hours after death.] 



The body of a slender Chinese from 25 to 30 years of age. Post- 

 mortem rigidity well marked ; post-mortem lividity moderate. The 

 surface is slightly cyanotic. There are no external wounds or 

 ulcerations. JSTone of the superficial lymphatics are palpable. On 

 section the veins discharge a good deal of dark, fluid blood. The 

 muscles are fairly moist and reddish-brown. The serous membranes 

 are injected and dull. The pericardium is much congested, but 

 the pericardial fluid is normal. The heart is normal in size, the 

 left ventricle well contracted and the right one dilated. The 

 anterior surface of the left ventricle, the apex on all sides, and the 

 sulcus show numerous small subepicardial hemorrhages. Both sides 

 contain gelatinous coagula. The myocardium is rather soft, pale, 

 and reddish-pink. Otherwise the heart is normal. The aorta 

 and coronaries are normal. Lungs : The entire anterior and a part 

 of the posterior surface of the lower lobe of the left lung is com- 

 pletely adherent to the pleura costalis. After the removal of the 

 left lung it is found that the pleura pulmonalis of the lower lobe 

 is thickened, yellowish, and covered with a thin fibrinous deposit. 

 Both pleural sacs contain a slightly increased amount of fluid, 

 on the left side this is turbid and contains some fibrinous flocculi. 

 Externally the left lung is purplish-blue and the right one scarlet- 

 pink. On section it is found that the lower lobe of the left lung 

 contains a central area of pneumonic consolidation. In front this 



