139 



bladder may likewise contain bloody urine or even blood coagula. 

 Like the mucosa of the pelves, that of the ureters and the bladder 

 occasionally shows petechia and ecchymoses. 



The suprarenals are generally somewhat swollen, enlarged, soft- 

 ened, and congested, and darker in color than normal. We have 

 not found any marked histologic changes in them, aside from 

 dilatation and engorgement of the capillaries, conditions which are 

 particularly noticeable in the interfascicular capillaries of the 

 cortex. 



THE LIVER AND THE GALL BLADDER. 



The liver is generally of normal size, though it may be slightly 

 enlarged. In those cases where we have found a decrease it was 

 clearly not due to the plague infection but to inorbid conditions 

 previously existing. The capsule is smooth and tense ; its external 

 color is deep purplish-blue or purplish-pink. Evidences of a minor 

 or more pronounced degree of fatty degeneration are rarely miss- 

 ing. Alternating with the general purplish color we find areas 

 which are grayish-white or grayish-yellow. The cut surface shows 

 a brownish-red or ocher-yellow color according to the degree of 

 fatty infiltration and degeneration, and the veins discharge much 

 blood. In septico-pyemic cases we encountered necrotic, soft, 

 grayish-white foci. These may also shine through the surface and 

 may have been noticed before the organ is cut into. The liver 

 lobules are either distinct or more or less indistinct; and their 

 boundaries may frequently be even more distinct than under normal 

 conditions, which is due to the fact that interacinous, periportal, 

 inflammatory foci are often encountered in the liver in cases of 

 plague. They were found in cases Nos. 1, 2, 3, 7, 8, 9, 10, 14, 16, 

 17, and 20. The microscopic examination, aside from these foci, 

 further shows dilated, engorged capillaries. The parenchyma cells 

 are finely or coarsely vacuolated or in a condition of cloudy swell- 

 ing or more or less complete granular degeneration. In uncom- 

 plicated cases of bubonic plague the parenchyma cells are not 

 profoundly changed; but in septico-pyemic cases the change is 

 generally quite profound. The necrotic foci, if present, contain 

 large numbers of bacilli and frequently show capillaries more or less 

 completely occluded by metastatic emboli. The cells in this neigh- 

 borhood are in a condition of complete coagulation necrosis, which 

 extends beyond the groups of bacilli into the adjacent tissues. 

 Phagocytic, proliferated endothelia are sometimes seen in the liver. 



