113 



laries and in some of the smaller pulmonary veins; it is present 

 both in the shape of a reticulnm and in that of tubidar or solid 

 thrombi. Here and there an extension of the intravascular fibrin 

 into the vessel wall and into the perivascular tissue is encoun- 

 tered. The interalveolar septa in this case, unlike those in the 

 preceding one, are not at all widened but rather delicate, excepting 

 the space occupied by the distended capillaries. Bacilli are found 

 extensively throughout the sections ; here and there in a dense clump 

 located in an alveolus and in other places distributed in such a 

 way that it may be said that the cells of the exudate are embedded 

 in a loose reticular matrix consisting of plague bacilli. In the 

 renal tissue the tubular epithelium shows cloudy swelling, granular 

 and fatty degeneration, and a loss of nuclei. Many of the tubules 

 are collapsed and the interlobular connective tissue is oedematous 

 The capillaries, includging those of the glomeruli, are congested, 

 and a few microscopic areas of blood extravasation are found near 

 the capsule. Sections of the liver show cloudy swelling and fatty 

 degeneration of the parenchyma cells and great congestion of the 

 capillaries and veins. However, there are no interstitial changes. 

 The lymph glands exhibit engorgement of the blood vessels and 

 lymph channels, some slight oedema, possibly some increase in 

 fibrous connective tissue, and the presence of quite a number of 

 plasma mast cells. Otherwise no changes have occurred. The 

 vessels of the gastric and duodenal mucosa are greatly engorged, 

 and some blood extravasation has taken place into the mucosa upon 

 its surface. N"o plague bacilli are found in these small hemorrhagic 

 areas ; in fact, practically none of these organisms are found outside 

 the pulmonary tissue. (The tissue from the spleen of this case 

 had been lost.) 



GROUP V. PRIMARY PLAGUE PNEUMONIA WITH SECOND- 

 ARY PLAGUE SEPTICO-PYEMIA. 



Case No. 19. Primary Plague Pneumonia with Secondary 



Septico-Pyemia. 



[Necropsy Protocol No. 962. F. S., Pilipina, female, 30 years old, from No. 148 

 Calle Anda, Intramuros, Manila. Died May 7, 1904, at 5.30 p. m. Cause of 

 death unknown. Plague suspected. Post-mortem examination made sixteen 

 hours after death.] 



The body of a fat, stout woman, probably 40 years old. Post- 

 mortem rigidity moderate; lividity well marked. The posterior 

 surface and the sides of the trunk, as well as the extremities, show 



25483 8 



