206 STRONG, CROWELL, AND TEAGUE. 



One sees beneath the pleura fine yellow and red dots and spots caused 

 by numerous yellow nodules or bands upon a bright red background. The 

 picture resembles exactly the one encountered in many lymph glands which 

 contain numerous bacilli. Microscopical sections show that this picture 

 is due above all to the fact that the distended alveoli are filled with 

 enormous masses of bacilli or with blood and with these almost alone; 

 the cut section shows a similar, generally mixed yellow-red color, appears 

 as though most finely shagreened but never really granular, and yields 

 an abundant, somewhat viscid juice. 



The changes in the septa of the alveoli are very characteristic and 

 indeed as well in the primary as in the secondary pneumonias. The septa 

 are very strikingly broadened and changed into a glistening frame-work 

 which is sometimes coarser, sometimes more thread-like, and stains well 

 with eosin. Between the bands of this frame-work are enclosed, in scant 

 numbers, cells or cell nuclei or red blood-cells: the thick cords are lined by 

 small and most minute granules standing close together and by cell 

 nuclei, irregular, pear-like, or spermatozoon-like in shape. 



The complete agreement with the changes in the vessels of primary 

 buboes and with the multiple foci in the spleen is obvious at the first 

 glance. The large numbers of plague bacilli in the alveoli lead also in this 

 case to that peculiar coagulation of the tissue-fluid and the cellular 

 elements of the septa of the alveoli and the vessel-walls; at the same 

 time coagulation takes place in the blood within the vessels. The finer 

 or coarser bands, which thus arise, do not give the fibrin-staining reac- 

 tion of Weigert. 



In addition to these changes in the septa of the alveoli, which are to be 

 regarded as due to necrosis, there appears at places a complete disap- 

 pearance of the septa, so that only spur-like remnants of the same are 

 left. The bronchioles are also markedly dilated and filled with enormous 

 masses of bacilli, which occur also in just as large numbers in the large 

 bronchi and are of course expectorated. However, fibrinous exudation is 

 everywhere almost completely lacking, only a scant fibrin network being 

 found here and there. The amazingly large number of plague bacilli is 

 also evident from cover-slip preparations and from cultures from the pneu- 

 monic lungs. In primary plague pneumonias, we found plague bacilli 

 twice in pure culture and once mixed with a small number of diplococci 

 {Diplococcus pneumonise) , in the metastatic foci only once in pure culture 

 and three times with diplococci, which were also in these cases not numerous. 

 We, of course, found a mixture of different bacteria in the pneumonic 

 foci due to aspiration. 



With regard to the frequency of the occurrence of pneumonic foci due 

 to the plague bacillus, among 44 acute plague cases we found such foci 

 nine times; viz., 3 primary plague pneumonias, 4 metastatic or secondary 

 plague pneumonias, and 2 aspiration pneumonias in which we could de- 

 monstrate numerous plague bacilli. The metastatic plague foci in the 

 lungs hence occur rather seldom if one considers that undoubtedly the 

 circulation is flooded with plague bacilli, either only for a short time or 

 frequently several days before death. 



The Anglo-Indian Plague Commission ^ report "that the lesions in pri- 



* Report of the Indian Plague Commission (1901), 5, 435. 



