117 



cells show marked fatty degeneration. In the spleen the j\Ialpigliian 

 bodies and the pulp spaces are not well marked, and the latter are 

 densely tilled. The proportion of leucocytes is increased. The 

 pulp spaces here and there show numbers of bacilli in fairly dense 

 groups; but they are not nearly as crowded in the spleen as in the 

 kidneys and liver. The gastric mucosa shows degenerative changes 

 in the glandular cells, in most of which the nucleus stains poorly 

 or not at all. Plague bacilli are found here and there in the loose 

 connective tissue of the mucosa. The interlobular capillaries are 

 enormously dilated, and blood is extravasated into the inter- 

 glandular tissue and upon the free surface of the mucosa. Few 

 plague bacilli are found in the oedematous and hemorrhagic inter- 

 glandular tissue and in the areas of blood extravasation upon the 

 mucosa. However, in general, the blood vessels do not contain any 

 plague bacilli. The uterine mucosa is quite oedematous and its 

 vessels much congested. Otherwise the uterus does not show any 

 marked changes. 



A consideration of the morbid anatomy and of the histopathology 

 of this case shows that we are dealing with a primary plague pneu- 

 monia, in which the virus was very promptly carried by the blood 

 current from the lungs to the distant organs. It is probable that 

 the plague bacilli first entered the lungs by inhalation, multiplied in 

 the alveoli, and invaded some of the interalveolar capillaries, where 

 they formed solid thrombotic masses. Particles of the latter taken 

 up by the blood current reached the kidneys, liver, spleen, etc., 

 where in several instances they grew into completely obliterating 

 emboli. It is a most remarkable fact that, in spite of the many 

 bacterial foci interpolated into the vascular system, the general 

 blood current did not become flooded with bacteria. In general the 

 lumina of the vessels, both large and small, are found free from 

 bacteria. Another point of great practical importance may be 

 learned from a histologic stiidy of this case, namely, that not 

 merely the sputum but vomited matter, feces, and urine may be 

 highly infectious. 



GROUP VI. PRIMARY PLAGUE SEPTICAEMIA. 



Case No 20. Primary Plague Septicemia. 



[Necropsy Protocol No. 983. L. T. T., Chinese, male, 28 years of age, from 

 No. 211 Santo Crlsto Street, San Nicolas. Sick for ten days; died June 4, 

 1904, at 1 a. m. Post-mortem examination made fifteen hours after death.] 



The body of a rather small, slender, young male Chinese, about 

 35 to 30 vears old. ISTutrition onlv fair, rather emaciated. The 



