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rhagic spots. On section the glomeruli and straight vessels are 

 much engorged, the uriniferous tubules grayish-yellow and the 

 surface dull. The mucosa of the pelves is injected, showing a 

 very few small punctif orm hemorrhages ; the ureters likewise exhibit 

 a few petechise. The mucosa of the bladder is thickened and 

 contains very numerous, densely crowded small petechias. The 

 suprarenals are swollen, soft, and yellowish-brown in color. The 

 liver is large, with rounded margins. Its capsule is smooth and 

 transparent and externally is bluish-purple, alternating with 

 yellowish-gray. On section the surface is dull and grayish-yellow 

 and the veins contain much blood. The consistency is markedly 

 increased; the acini enlarged. The gall bladder is distended with 

 a good deal of dark green viscid bile. The ducts are open; there 

 are no stones. The mucosa of the stomach and the small intestine 

 shows numerous small, irregular hemorrhagic areas. Both the 

 superficial and the deep lymph glands are very little, if at all, 

 enlarged, though they are markedly congested, particularly the 

 mesenteric and the inguinal ones. 



Anatomical diagnosis. — Congestion and oedema of the lungs; 

 fatty degeneration of the liver; acute parenchymatous nephritis; 

 multiple subserous and submucous hemorrhages (lungs, heart, 

 kidneys, ureters, bladder, stomach, intestines). Plague septicaemia. 



Smears from the different organs, including the glands, spleen, 

 liver, limgs, etc., show a moderate number of plague bacilli. Tubes 

 inoculated from the blood, the lungs, and the glands developed 

 tj'pical plague bacilli, but the cultures were contaminated by a 

 small diplococcus. 



Microscopic examination. — The histologic changes in the kidneys 

 are very profound. There is universal cloudy swelling and fatty 

 degeneration of the tubular epithelium. The tubules are generally 

 filled with a granular detritus, and in many instances sharply out- 

 lined hyaline casts are found. These hyaline masses are composed 

 of a homogeneous material (staining with eosin and somewhat 

 with methylene blue) ; however, this does not give the tinctorial 

 fibrin reaction. While the degenerative changes of the renal 

 epithelium are. most pronounced in the convoluted tubules, they are 

 also present in the straight ones. The glomerular capillaries are 

 generally not much altered, but here and there a partial hyaline 

 (fibrin) thrombosis can be seen. Occasionally one observes an inter- 

 tubular thrombosed vessel. Plague bacilli are found in small 



