131 



have never been able to find any bacilli in the subepicardial hemor- 

 rhagic areas.^ 



THE LUNGS. 



The lungs, in uncomplicated eases of bubonic plague as well 

 as in complicated ones, in fact in all cases of pest which we have 

 examined, show great congestion and oedema, with a corresponding 

 diminution of the amount of air contained in them. The external 

 surface is generally of a deep purplish color; the cut surface dis- 

 charges a large quantity of blood and serous fluid. The mucosa of 

 the bronchi, the trachea, and the larynx is more or less swollen, con- 

 gested, and reddened. Hemorrhages are found on the pleural 

 surfaces and sometimes on the mucosa of the bronchial tract, 

 including the larjTix; in one of our cases they were found in the 

 epiglottis. In cases of primary or secondary plague pneumonia 

 we find interlobular foci in the lungs, varying in size from that 

 of a mere point to that of a hazelnut. They are generally well 

 consolidated and in color grayish-reddish-white to brownish-red. 

 They are, as a rule, surrounded by a ring of intensely congested, 

 deep reddish-brown pulmonary tissue. The areas of lobular con- 

 solidation may become confluent so as to produce a picture of 

 complete lobar consolidation. We have not observed such cases, 

 but others have established their occurrence.^ In one of ours the 

 pneumonic area reached to the pleural surface, where it had pro- 

 duced a localized exudative, fibrinous pleuritis. In general it is 

 found that if the areas of lobular consolidation are situated near the 

 surface, the pleura in this region is somewhat prominent and 

 imeven, and is quite well differentiated from the surrounding sur- 

 face. In plague pneumonia the bronchial glands may or may not 

 assume the character of primary buboes. They may be enlarged,, 

 greatly softened, and hemorrhagic, or they may show but very 



* No mention of the myocardium is generally made in the microscopic 

 reports of the twenty individual cases reported above. However, the heart 

 and other organs not specifically mentioned, such as the suprarenal glands, 

 the pancreas, male and female genital organs, etc., were examined micro- 

 scopically in most of the cases. Since no changes of a marked character 

 or of particular interest were found, these findings have not been given 

 in detail but are only referred to in the summary. 



* In case No. 18, the same which showed the localized fibrinous pleurisy, 

 most of the left lower lobe was consolidated. So this case came very 

 near being a lobar pneumonia. 



