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cases in whie]i a diagnosis is impossible. When a plague infection 

 has run its course without having in itself killed the patient, he 

 may nevertheless succumb to a secondary pyogenic complication, to 

 parenchymatous degeneration of the internal organs or to exhaus- 

 tion due to toxemia, any one of which may carry off the victim 

 after the plague bacilli have disappeared from the primary bubo 

 and from the system at large. Of course such exceptional cases 

 are of no great epidemiological importance, since a spread of plague 

 can not occur if no more bacilli are present. In the great majority 

 of fatal cases of human plague the post-mortem diagnosis, to one 

 familiar with the disease and with the ordinary technique of 

 bacteriological investigation offers no particular difficulties. The 

 diagnosis of plague in rat cadavers which are much decomposed is 

 a matter of much greater difficulty, hut in this article this is a 

 subject with which we not concerned. 



The report of the Indian Plague Commission (Vol. V, p. 442) 

 gives the following description of the body of a patient dead of 

 plague : 



The body, if undisturbed, is stated to be generally lying on one side, 

 with the knees flexed, and the head slightly bent on the chest. The 

 skin in dry, and in a few cases petechise and purpuric spols may be 

 seen; the muscles are soft, as the rigidity of death is delayed; the features 

 retain a fixed, anxious appearance; the eyes are half closed and sunken, 

 Avith the pupils dilated; and the tongue is swollen, and although it 

 sometimes has the appearance displayed during life, not unusually it is 

 covered with a dry, almost horny dark or yellowish-bro^\Ti and cracked 

 fur. In pneumonic cases, the body seems especially shrunk and collapsed 

 and has a livid aspect, and blood-stained sputum is often found adherent 

 to the lips. Our attention was drawn by Captain Elphink, I. M. S., to 

 the existence of cedoma, extending over the front and sides of the chest, 

 the abdomen, and the upper part of the arms, which had been observed 

 by him and by Captain Chaytor-White, I. M. S., in all plague corpses, 

 and was believed to occur immediately before death. If this condition 

 is generally present, it would be valuable as an aid in determining if 

 death had been caused by plague, and especially in cases where no 

 buboes are present. It has not, however, been observed bj' the great 

 majority of those who in India have had the opportunity of seeing large 

 numbers of fatal cases, both before and after death. 



This guide to the post-mortem diagnosis of ])lague is evidently 

 not intended for the pathologist performing a necropsy, but for 

 the general practitioner or the layman-sanitary inspector of India. 

 But we seriously doubt whether anybody will be materially assisted 

 in a plague diagnosis by so vague a description as that given 



