954 The Philippine Journal of Science 1915 
SEPTIC4sMIC PLAGUE 
While these two types of plague (primary bubonic and primary 
pneumonic) are universally recognized, other types of the disease 
have been described by various authors. The Anglo-Indian 
Plague Commission*® recognizes four types of the disease: 
namely, (1) bubonic, (2) septicemic, (3) pneumonic, and (4) 
pestis minor or ambulans. In this classification they refer to 
a primary plague septicemia, and present the following descrip- 
tion of the type: 
Distinguishable clinically though, from the point of view of the path- 
ologist, not sharply marked off from the secondary plague septicemias just 
described, are the cases of plague commonly spoken of as septicemic, in 
contradistinction to bubonic cases. These are the cases where, owing to 
the more rapid passage of bacteria through the lymphatic filter, and 
possibly to a greater production of bacterial poisons, the constitutional 
symptoms precede and overshadow the local symptoms, the disease being in 
most cases rapidly fatal. 
In another part of the same report we find the following: 
Intense or septicemic type of plague.—In those cases in which the plague 
virus or toxin is in the patient widespread from the beginning of the illness, 
so as early to produce a general poisoning, whether septicemie or toxemic, 
the pathological changes, as might be expected, are much the same as in 
the more severe cases of Pestis major. Some observers, however, believe 
that pathological differences occur to distinguish this form of plague, and 
to serve, along with the symptoms, as a justification for the establishment 
of a so-called septiceemic type of the disease. They consist of the absence 
of buboes having the characters above described, and of a widespread in- 
volvement of glands, with distinctive changes in several of them. Although 
the lymphatic glands are always affected, in place of the affection consisting 
of one or, more rarely, of several groups of glands being enlarged and 
surrounded with sero-sanguineous extravasation, while the other glands 
are either normal or merely enlarged or congested, in this, the so-called 
septicemic form, the affection of the glands shows itself as a general 
involvement of all, or nearly all, of the lymphatic glands of the body, 
although in many instances the affected glands were chiefly those of the 
mesentery. In no case, however, did the involvement proceed to the forma- 
tion of the characteristic plague buboes, but only to a moderate degree of 
change, practically restricted to the glands themselves, but still displaying 
in several of them certain distinctive features. These were moderate 
enlargement and cedema without much congestion, the glands being pink 
in color, firm and rounded, and with a soft interior, often possessing here 
and there small areas of softening surrounded by firm substance. Several 
of the affected glands may be thus modified, while others of them are merely 
enlarged and engorged with blood, thus resembling the less affected glands 
of ordinary Pestis major. Excepting the lymphatic glands, the parts that 
were affected showed essentially the same pathological changes as in the 
* Report of the Indian Plague Commission (1898-99), 5, 54. 
