204 STRONG, CROWELL, AND TEAGUE. 



on the front of the right lung, and two similar but smaller patches at the 

 same part of the left lung; these patches stood out a little from the 

 surface, and were airless, friable, and sank in water, each was surrounded 

 by a dark ring of engorgement, which merged into the healthy lung, and 

 there was recent pleurisy over the pneumonic areas. All the other organs 

 were examined, and showed considerable engorgement, but no special lesion 

 was observed. The cervical, the axillary, and the lumbar lymphatic glands 

 were slightly enlarged; the left iliac slightly enlarged, red, and soft; all 

 the other glands, including the bronchial, looked absolutely normal." 



Childe states that he had performed 12 post-mortem examinations on 

 pneumonic-plague cases all presenting appearances similar to those described 

 in the one above. 



In his later publication in 1898,^ he describes the pneumonic form of 

 plague as follows: 



"In this form of plague, the only marked evidences of disease are found 

 in the lungs; the lymphatic glands and other organs are scarcely affected 

 at all. 



"The Condition of the Lungs. — There was general engorgement with con- 

 siderable oedema, a reddened condition of the mucous membrane of the 

 bronchi, but no marked evidences of bronchitis, and frothy watery fluid, 

 sometimes blood-stained, could be squeezed from the bronchi. (Pus in the 

 bronchial tubes was only found on one occasion.) A number of pneumonic 

 patches were found scattered through the lungs, varying in size from a 

 pea to an egg. They were light pink or red-grey in colour, solid, airless, 

 and sank in water; they were rounded in shape, and usually separated by 

 a distinct ring of engorgement from the crepitant lung around. Some, 

 instead of being pink, were of a deep blood colour throughout, and less 

 solid, and some of these had a small, greyish, more solid centre. Those 

 of the patches which were situated on the surface of the lung were prom- 

 inent, and projected distinctly from the surface; whilst the pleura over 

 them was roughened, and showed signs of early inflammation. These 

 patches had, in fact, the appearance of the first and second stages of lobular 

 pneumonia, but no patches were found which had passed on to the third 

 stage of softening and breaking down. In a few cases larger masses of 

 pneumonic lung than these were found, and once about half the lower 

 lung was found in this condition. Petechial haemorrhages were usually 

 found on the surface of the lung; the bronchial glands were either enlarged, 

 swollen, oedematous, soft, and distinctly engorged, or else they were small 

 and of the usual appearance, perhaps a little engorged. The remaining 

 lymphatic glands throughout the body showed none of the appearances of 

 either the bubonic or septicasmic form of plague; most of them looked 

 absolutely normal, and the only noticeable change was that the axillary, 

 and sometimes the cervical, chains were a little engorged. 



The description of the remaining internal organs already given applies 

 equally to this form of plague, except that the large hemorrhages were 

 absent, but petechia on the surface of the heart, in the pelvis of the kidney, 

 bladder, stomach, and intestines were commonly present. Petechiae in the 

 skin were not observed in this form of plague. * * * 



"A section of lung tissue, apart from a pneumonic area, shows great- 

 engorgement of all large blood vessels, and of the alveolar capillaries as 



■Ibid. (1898), 2, 859, 860. 



