140 



The gall bladder is generally normal; but it may sometimes be 

 profoundly chauged, showing numerous subserous hemorrhages and 

 a comj^letely oedematous and almost gelatinous condition of the wall. 

 The bile itself varies from a normal consistency and golden-yellow 

 color to a pitchy condition and almost black color. The serosa of 

 the gall bladder, like that of the liver, occasionally shows extensive 

 ecchymotic spots. 



We have not encountered any marked macroscopic or microscopic 

 changes in the pancreas. 



THE STOMACH AND THE INTESTINES. 



The stomach and the intestines are generally markedly affected 

 in plague. Petechige and ecchymoses are found both in the serosa 

 and in the mucosa. Particularly the gastric mucosa is generally 

 in a hemorrhagic condition. The petechiae often extend into the 

 duodenum and occasionally even into the esophagus. Microscop- 

 ically, the mucosa of the stomach always shows greatly dilated 

 interglandular vessels and frequently hemorrhages between the 

 glands and into the uppermost layers of the mucosa or even upon its 

 free surface. Plague bacilli were found in these areas only in 

 septico-pyemic cases. The upper layers of the mucosa are often 

 necrotic; and the cells of the peptic glands, even where the mem- 

 brane is still fairly intact, show evidence of nutritive disturbance 

 (multinuclear cells). The small and large intestine in general 

 frequently show a great congestion of the mucosa and serosa with 

 petechia and ecchymoses. In one case submucous blood cysts were 

 found in the large intestine ; these were probably due to the plague 

 infection, as other, higher parasites could not be demonstrated in 

 them. In a considerable proportion of our material the intestinal 

 follicles were more or less swollen, viz, moderately in cases Nos. 6, 

 7. 15, and 17, and markedly in cases i^os. 1, 5, and 12, and highly 

 in case No. 2. In the other cases the intestinal lymph follicles 

 were normal. 



STEPS IN ESTABLISHING THE POST-MORTEM DIAGNOSIS 



OF PLAGUE. 



We shall now mention briefly, but systematically, all observa- 

 tions and experiments which will in a given case of suspected 

 fatal plague enable us to come to a definite and conclusive diagnosis. 

 However, it must be borne in mind that there are some exceptional 



