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pericardium are often distinctly visible as red tortuous streaks and 

 lines. The pericardial fluid is normal or somewhat turbid and 

 occasionally more or less increased in amount. The left ventricle 

 is contracted and the right one sometimes considerably dilated. 

 We have never seen endocardial hemorrhages or endocarditic proc- 

 esses. However, Duerck has described a case of plague pneumonia 

 with endocarditis verrucosa of the mitral valve, further com- 

 plicated by a purulent leptomeningitis of the convexity. This 

 case was evidently one of septico-pyemic plague endocarditis. The 

 myocardium is frequently of good consistency and of normal color ; 

 although sometimes it is rather soft, flabby, friable, pinkish-yellow, 

 and easily torn. Both sides generally contain chicken-fat clots 

 and much dark, fluid blood. The great vessels present no changes 

 peculiar to plague; but in Case No. 16, an ambulatory one, we 

 found an embolism of the pulmonary artery. In general the veins 

 and capillaries are dilated and engorged to such an extent that 

 some of the internal organs, more particularly the lungs and the 

 kidneys, are not only greatly congested but highly oedematous. If 

 one considers the great dilatation and engorgement of the vascular 

 system and the oedematous infiltration of the tissues met with in 

 plague, one is inclined to think of a hydremia of the blood. Such 

 a condition might easily be brought about in consequence of the 

 vasomotor and secretory disturbances which exist in plague, namely, 

 scanty or suppressed urine and dry skin on the one hand, with great 

 thirst and a larger ingestion of fluid on the other. Whether a 

 hydrsemia of the blood really exists in plague is a point, which, 

 as far as we know, has never been determined. This question could, 

 of course, not be decided by a count of the corpuscles, but only by 

 exact chemical methods for determining water and dry residue. 

 The dilatation and engorgment of the vascular system often 

 shows the smallest veins in the serous and mucous membranes as 

 distinct, more or less tortuous lines, while the overfilling of the 

 capillaries in the membranes named produces a uniform deep 

 hypersemia. In areas of this kind petechia and ecchymoses are 

 encountered. Microscopically the myocardium often does not show 

 any marked changes. In other cases a moderate degree of fatty 

 degeneration, pigmentary degeneration of the perinuclear zone, 

 fragmentation or segmentation are met with. However, in general, 

 the histologic changes of the myocardium are insignificant. We 



