PATHOLOGY. 207 



mary pneumonic plague, when contrasted with those occurring in Pcatis 

 major, are less intense in the other orj;:ans, with the exception of the lungs. 



"The lymphatic glands are only slightly affected, and external buboes 

 having the specific characteristics seen in I'cstls major are seldom, if ever, 

 encountered. Congestion and enlargement of organs and even haemorrhage 

 in mucous and serous membranes may be present, but they do not assume 

 the proportions attained in Pestis major. On the other hand, the lungs 

 are conspicuously affected. The whole substance is engorged, the large 

 as well as the small blood vessels being distended; and haemorrhagic zones 

 are seen scattered throughout the lungs, filling the alveoli and often break- 

 ing down their walls. Within the hjemorrhagic zones are areas in which 

 the alveoli are completely filled with leucocytes, epithelial cells, and gran- 

 ular debris, constituting, with the surrounding zones of haemorrhage, 

 blood-congested areas of catarrhal pneumonia. In these areas, as well 

 as in the fluid matter contained in the trachea and bronchi, plague bacilli 

 are abundantly present. Greyish necrotic patches have also been found 

 containing large numbers of plague bacilli. The bronchi are engorged 

 with blood, and catarrhal cells are found in their terminations. Over 

 affected areas at the surface of the lungs, the pleura may be acutely in- 

 flamed. In most cases, the bronchial glands were congested, and there 

 was a little haemorrhage into the gland substance; but in some cases, their 

 appearance was normal. 



"While, however, a catarrhal inflammation of lobular distribution has 

 most frequently been regarded as the characteristic type of primary plague 

 pneumonia, several observers have denied its existence, and have asserted 

 that croupous (lobar) pneumonia is the form that most frequently occurs. 

 Major Evans, I. M. S., and Captain Elphick considered that all cases of 

 typical plague pneumonia come under the latter category, and Major Jones 

 expresses the opinion that "lobar pneumonia is common." Major Evans 

 stated that the pneumonia is distributed in small detached patches, con- 

 stituting lobular areas, only when the inflammation has not advanced far; 

 but that it is lobar to the extent of involving a whole lobe or the greater 

 part of a lobe when the lung inflammation has advanced further. Captain 

 Elphick, I. M. S., described several autopsies in which individual lobes or 

 even an entire lung was consolidated, and he stated that "every case of 

 pneumonic plague examined showed lobar condensation." It may further 

 be stated that in many cases only slight changes were found in the bronchi. 

 It is therefore possible that the pneumonia is lobular in patients who have 

 died at an early stage of the disease, and lobar in those who have sur- 

 vived to a later period; or, otherwise, that lobar pneumonia occurs when 

 the toxin is most virulent and most widely distributed throughout the lung, 

 and lobular pneumonia when it is less virulent and less widely diffused. 



"* * * [The] microscopic examination has mainly shown general dila- 

 tation and engorgement of the veins and smaller blood vessels and nu- 

 merous capillary and larger haemorrhages in almost every structure and 

 organ of the body." 



Diirck ° and Herzog ' have reported at some length upon the general 



' Beitrage zur pathologischen Anatomie und zur allgemeinen Pathologie 

 (1904-5), Supp. 6-7. 



'Pi(b. Bur. Govt. Labs. (1904), No. 23, 9. 



