123 



but quite exceptional ways in which plague may be carried about to 

 distant centers over sea, are, it must be observed, of extremely rare 

 occurrence. One such case has, however, come unoificially to our knowl- 

 edge in Poona." 



THE LYMPH GLANDS IN BUBONIC PLAGUE. 



In the majority of cases the portal of entrance of the plague 

 bacillus is through the skin or the mucous membranes. We have 

 already emphasized the fact that there is no case of human plague 

 on record in which the entrance of the bacillus through the intes- 

 tinal mucosa could be demonstrated beyond doubt. After the plague 

 bacillus has gained access to the body, it generally travels through 

 the lymph channels to the nearest gland or glands, where it then 

 multiplies. Indeed, the multiplication of this organism in the 

 lymph glands in most cases of bubonic plague is undoubtedly in 

 excess of any other bacterial proliferation in any other infection, 

 not excluding lepra. In the lymph glands the changes produced 

 may vary from comparatively minor ones to those of the most 

 profound degree. From a study of the lymph glands in the various 

 stages of the infection it appears that the first change produced 

 is vascular dilatation and engorgement and oedematous infiltration 

 with a perivascular proliferation of the connective tissue elements. 

 Even in cases of mild infection, one generally finds an increase 

 of connective tissue at the hilum and usually marked vascular 

 dilatation and oedema of the gland. The effect of the toxines and 

 the other metabolic products of the proliferating bacilli clearly 

 brings about an early damage to the vessel walls. However, this 

 damage may not find a pronounced morphologic expression. From 

 statements made in literature it appears that a well-marked hyaline 

 degeneration of the vessel walls is always found. We can not 

 confirm this observation, because we have frequently found an 

 infected gland with vessels, the walls of which, to all intents and 

 purposes, appeared to be morphologically intact. However, there 

 always is noticeable a great dilatation and engorgement of the ves- 

 sels, factors which, as we well know from general pathology, are 

 perfectly sufficient so to damage the vessel walls as to render them 

 pervious to the serum and to the corpuscular elements of the cir- 

 culating blood. Hence, it is not necessary, in order to explain 

 some of the tissue changes in plague, always to look for a degenera- 

 tion of the vessel walls with grave morphologic changes. After a 



