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plague infection and succumbed speedily before the characteristic 

 tendency to free hemorrhage could bcorae manifest. 



The Austrian commission, in particular, held that multiple 

 hemorrhages in plague are dependent upon the direct presence of 

 bacilli. However, this view is not adopted by most observers; 

 agreeing with the majority of authors we are strongly opposed to 

 it. In all of our cases we examined the hemorrhagic areas care- 

 fully and in the larger number of them found the petachise and 

 ecchymoses free from them. Plague organisms were found only 

 exceptionally in the hemorrhagic areas, and only in such cases as 

 showed a septico-pyemic dissemination of the bacilli. To repeat, 

 in the greater number of cases of the uncomplicated types of bubonic 

 plague, we were unable to detect any bacilli in the numerous 

 subserous and submucous hemorrhages. 



The German commission was never able to find any bacilli in 

 the juice obtained from the petechise; and several authors have 

 reported the typical occurrence of hemorrhages in guinea pigs 

 killed by dead cultures of plague bacilli. We have likewise suc- 

 ceeded in producing extensive blood extravasations in distant 

 organs in guinea pigs killed by intraperitoneal injections of dead 

 cultures. Hence, we must hold that the hemorrhages are entirely 

 independent of the local invasion of living plague bacilli and are 

 due to the toxines which have entered the general blood current. 



PLAGUE AS A RULE NOT A GENERAL MICROBIC 



INFECTION. 



In uncomplicated cases of bubonic plague, even when the infec- 

 tion of the glands is extensive, bacilli are generally not found in 

 the vessels. In fact, one may observe an area composed almost 

 exclusively of zoogloeal masses of bacilli, in which there is still 

 found a vessel with a comparatively intact wall and with a lumen 

 entirely free from plague bacilli. In the introduction we have 

 already called attention to the fact that the results of our investiga- 

 tion do not justify us in classifying plague, in the strict sense of 

 the word, as a general hemorrhagic septicemia, but as a local infec- 

 tion with general symptoms and a general hemorrhagic toxemia. 



From a histologic study of our material, we have come to the 

 conclusion that a general dissemination of the bacilli from the 

 glands is the exception and not the rule. Usually the infection 



