continuous chain of glands, swollen, .softened, and hemorrhagic, 

 extending from below Pupart's ligament to the kidneys and 

 embedded in a completel}^ hemorrhagic and gelatinous connective 

 tissue. The same may be true of the axillary glands where the 

 typical changes and the hemorrhages may extend from the axillary 

 space into the thoracic cavity, and in the case of the cervical glands, 

 from the most superficial cervical to the deepest submental lymph 

 nodes and even in to the mediastinal glands. 



THE OTHER LYMPH GLANDS IN PLAGUE. 



Aside from the primary bubo with its hemorrhagic glands of the 

 first, second, third order, and so on, the glands in general may pre- 

 sent a greatly varied appearance, and we find all gradations from 

 the most profound to very insignificant changes. Tn septico-pyemic 

 cases metastatic emboli may be carried from the primary bubo 

 into a distant gland, and there establish a secondary bubo, which 

 does not differ materially either macroscopically or microscopically 

 from the former. But even in uncomplicated cases, without septico- 

 pyemia, the distant glands may l)e much swollen, greatly softened, 

 and highly congested, or they may practically show no changes at 

 all. Only a few glands may be affected, or many of them may 

 exhibit marked pathologic changes. In general, the rule holds good 

 that the more marked the tendency to widespread, subserous and 

 submucous hemorrhages, the more pronounced the swelling, etc., 

 of the lymph glands, both superficial and deep. In plague pneu- 

 monia the bronchial glands may have the appearance of a primary 

 bu])o, or they may merely show some swelling, softening, and con- 

 gestion, without any blood extravasation. The lymph vessels 

 proper, aside from those situated in the infected glands themselves, 

 are as a rule not much changed, excepting those which connect the 

 different glands of the chain forming the primary bubo. 



THE HEART AND THE CIRCULATORY SYSTEM. 



As a rule the heart does not show any very pronounced changes 

 in plague, aside from those which are found as common features 

 in the various organs in this disease. The great frequency of 

 subepicardial hemorrhages has already been pointed out. The 

 coronar}^ vessels are generally greatly dilated and engorged, and the 

 smaller ones of both the visceral and the parietal layers of the 

 25483 9 



