182 STRONG AND TEAGUE. 



in one instance of this nature, occurring during the epidemic 

 and reported by Fujinami,^ the lymphatic glands of the neck 

 showed enlargement with haemorrhages, and the surrounding 

 tissues of the pharynx and larynx were very much affected, 

 while the lung was only very slightly involved. Obviously, this 

 case should be regarded as primarily of bubonic character. Both 

 the German and the Austrian plague commissions concluded that 

 primary plague septicaemia probably does not exist. However, 

 as has already been called attention to elsewhere in this report, 

 these commissions made their observations only during epidemics 

 of bubonic plague. From the studies made upon human beings 

 during the Manchurian epidemic, as well as from the animal 

 experiments performed in this laboratory,' we must conclude 

 that primary plague septicaemia does sometimes occur, death 

 resulting from this cause before lesions, which are macroscop- 

 ically recognizable, are present in the lymphatic glands or in 

 the lungs. 



Several cases of primary intestinal plague were reported at 

 the Conference in which bloody diarrhoea appeared to be the 

 most prominent symptom. None of these cases was studied at 

 necropsy. It appears that no definite evidence of the occurrence 

 of primary intestinal infection during the epidemic was produced. 

 In the few instances in which plague bacilli had been found 

 during the epidemic in the faeces, infection had evidently occurred 

 secondarily from the blood. Albrecht and Ghon in the report 

 of the Austrian Commission have reported the only suggestive 

 case of primary intestinal plague occurring during a bubonic 

 epidemic of plague, and even in this case the evidence of such 

 infection is not conclusive. However, it seems established that 

 primary intestinal plague has been produced in rats by feeding 

 large quantities of virulent plague bacilli. In many instances 

 during the Manchurian epidemic, the patients with pneumonic 

 plague must have swallowed enormous numbers of plague bacilli 

 in the saliva and sputum. Nevertheless, in none of the nec- 

 ropsies performed during the epidemic were evidences of pri- 

 mary intestinal infection present nor was serious involvement of 

 the intestine encountered. This fact certainly speaks strongly 

 against the existence of primary intestinal plague in man and 

 would seem to show that even if the intestines are sometimes 

 secondarily involved, this condition in human beings must be also 

 a very rare one. 



'Ibid., p. 150. 



' See IV, p. 173 of this report. 



