208 STRONG, CROWELL, AND TEAGUE. 



pathological anatomy of bubonic plague, but neither of these observers had 

 any special opportunity for the study of the primary pneumonic form. 



During the Japanese epidemic of 1899, reported by Kitasato, Takaki, 

 Shiga, and Moriya,^ 13 cases of primary pneumonic plague occurred, but 

 no necropsies were made. Sata * has recently reported upon the patho- 

 logical anatomy of a single case of pneumonic plague in which, however, 

 the lesions were complicated by the presence of other bacteria, besides the 

 plague bacillus. 



On account of this absence in the literature of observations 

 upon the pathological anatomy of epidemic pneumonic plague, 

 the results of the study of this subject made by us during the 

 Manchurian epidemic will be reported in detail. 



Our observations upon the human pathology of this disease 

 are based upon the study of 25 complete necropsies performed 

 at the plague hospital at Mukden. All of the material was fresh, 

 many of the necropsies having been performed immediately or 

 within a few hours after death. 



The histological examination of the tissues has been performed 

 in Manila since our return. Zenker's fixation with alcohol pres- 

 ervation of sections was employed in all cases, while primary 

 alcohol fixation of sections from some cases was also used in 

 order to facilitate bacterial investigation. It was necessary in 

 a few cases to resort to the study of the material which had been 

 preserved in Kaiserling's fluid. All tissues were sectioned in 

 paraffin and stained with Bohmer's hsemotoxylin and eosin; 

 in addition Weigert's stain for fibrin, Unna's methylene blue 

 and eosin, the Gram-Weigert stain, and Mallory's iron hsemotox- 

 ylin were used as differential stains in nearly all of the cases. 



It has been deemed advisable to consider the gross and his- 

 tological lesions under the description of each organ. 



External appearance. — The bodies with one exception were 

 those of robust, well-nourished individuals and showed no emacia- 

 tion. Two of the subjects showed evidences of old syphilitic 

 infection and one had early carcinoma. None of them was tuber- 

 culous. The superficial lymphatic glands were not enlarged, 

 and carbuncles, vesicles of the skin, or buboes were not observed. 

 Small punctiform haemorrhages in the skin about the bends of 

 the elbows and over the chest occurred in two cases and were 

 apparently the result of needling.^ Livor mortis was not as a 



' Bericht iiber die Pestepidemie in Kobe und Osaka. Tokio (1900). 

 'Quoted by N. Masuyama, Ztschr. f. klin. Med. (1910), 70, 498. 

 ' A method of treatment of the disease employed by certain Chinese 

 physicians of the old school. 



