180 STRONG AND TEAGUE. 



the mucous membranes of the mouth and throat. Primary 

 septicaemia may then result. In those instances in which the 

 infection is virulent and severe and the susceptibility of the host 

 marked, death may sometimes occur before bubonic involvement 

 is apparent. In other instances, bubonic involvement of the 

 glands of the neck and septicaemia are present. No true pneu- 

 monia occurs unless infection by inhalation has in addition taken 

 place. The German and the Austrian Plague Commissions con- 

 cluded that primary plague septicaemia probably does not exist. 

 However, these commissions made their observations only during 

 epidemics of bubonic plague. From our studies made upon 

 human beings, during the Manchurian epidemic, as well as from 

 the animal experiments quoted above, we must conclude that 

 primary plague septicaemia does sometimes take place and that 

 death may occur, though rarely, before visible lesions have taken 

 place either in the lungs or lymphatic glands. 



