412 The Philippine Journal of Science im 



plague, as was ascertained by examination of the organs after 

 death. 



Two of the patients, cases 8 and 12, had numerous plague 

 bacilli in the sputum at the time when the expectoration showed 

 the presence of blood (twenty-three and one-half and eighty-two 

 hours, respectively, before death). In 3 cases I was able 

 to prove the presence of Bacillus pestis in the skin lesions, 

 inti-a vitam, fifteen, twenty-two, and forty-eight hours, respect- 

 ively, before death. In case 18 there was no doubt that the 

 skin lesions, which covered the whole body and the face, were 

 of secondary nature, as the patient died shortly afterward. 

 It was undoubtedly a case similar to those reported by Gotschlich 

 and Zabolotny.' In the other two patients there was only 1 

 maculopapulous efflorescence on the foot in case 1 (with a cor- 

 responding femoral bubo) and 2 lesions of the same type on the 

 arm and forearm in case 4 (with a corresponding axillary bubo) . 

 It is possible that these lesions were the original port of entry 

 of infection. Numerous plague bacilli were found in the skin 

 lesions of these cases, both microscopically and in culture. 



The plague patients tabulated in Table II recovered. They 

 were all treated with antiplague serum. While cases 5, 2, 19, 

 and 24 appeared clinically to be rather severe, cases 2 and 20 

 were mild. 



It can be seen from the table that the plague bacilli may not 

 be detected in the enlarged gland at first (case 2) and that their 

 presence may be revealed only after repeated examination of 

 the bubo. It is also evident from the results of repeated exam- 

 inations that the plague bacilli disappear from the infected 

 gland in a comparatively short time, as a rule at the time when 

 pus starts to form. Contrary to the findings in patients who 

 died, distinct phagocytosis was noticed in the smears made from 

 the aspirated liquid in those patients who recovered and who 

 had been treated with serum soon after the onset of the disease. 

 It is undoubtedly this process that clears the gland of the 

 infectious agents. 



The general opinion in regard to the presence of Bacillus 

 pestis in the circulating blood seems to have been, as Thompson 

 remarks, that "the bacillus is rarely to be found in the peripheral 

 blood stream before the agonal stage." ^ 



The Austrian Commission, using few drops of blood, found 



' Kolle und Wassermann. Handbuch dei* pathogenen Mikroorganismen. 

 Gustav Fischer, Jena (1903) 2, 521. 



Vowm. Hyg., Cambridge (1906), 6, 558. 



