
x,B,4 Crowell: Pathologic Anatomy of Bubonic Plague 255 
bubonic variety of Pestis major, but usually the number of parts affected 
was smaller and the degree of change in them was less. 
From the pathologic standpoint the most detailed description 
of the so-called septiczemic type of plague is furnished by Childe.’ 
In the bubonic form of plague, one set of glands with extravasated blood 
around them forms the bubo, and there is practically no alteration in the 
remaining glands of the body; but in the septicemic form there is no such 
bubo, yet there is general involvement of nearly all the lymphatic glands. 
Yet though so many glands show evidence of disease, one gland or several 
glands of one set show characteristic changes which are pathognomonic of 
this type of plague. These appearances are:—The gland is enlarged to the 
size of an almond or less, is rounded, firm and pink in colour; on section 
it shows some but not much engorgement and some cedema, its substance 
is rather soft and can be easily scraped off with a knife, and sometimes 
small softening areas were present. There was no hemorrhage in the 
areolar tissue around this gland and at most only a little edema and 
trifling engorgement of the vessels. Commonly there were one or several 
such glands in one inguinal region, and usually the lowest gland of the — 
chain was most markedly affected; whilst those higher up varied in size 
from a bean to an almond, and had the same firm pink appearance though 
there were at times some which looked nearly normal in size and shape. 
The iliac glands of the same side were similarly affected, as large as 
almonds and either pink and firm or softer and of a dark red colour. The 
inguinal glands of the opposite side showed similar changes, but sometimes 
to a less extent, and the iliac sometimes showed ‘slighter changes or some 
of them looked normal. The lumbar usually showed slight enlargement 
and were either pale and soft or somewhat pink and firm. The cervical 
and axillary varied in size from hazel-nuts to peas and usually showed 
merely engorgement, being full of dark blood; but sometimes some of them 
showed the pink firm appearance described above. The mesenteric were 
enlarged to the size of peas and beans and were either slightly or con- 
siderably engorged. The supra-trochlear and popliteal were normal or 
engorged. There was no hemorrhage or cedema around any of the above- 
mentioned glands, and no enlargement of the lymphatic vessels was observed. 
The condition of the remaining organs was such as has already been 
described under the bubonic form. 
Note.—In several cases of Plague-septicemia where death had occurred 
shortly after attack, the glands were found slightly enlarged, of a dark red 
colour and contained much blood and cedema fluid. This appeared to be an 
earlier form of the characteristic pink plague glands described above. The 
difference between the bubonic and septicamic form of plague appears to 
be this:—In the bubonic form the plague bacillus after entering the body is 
arrested at the nearest group of glands, grows here vigorously, and as a 
result of its growth the bubo is formed. Here the bacillus forms the toxins 
which are discharged into the system and cause the symptoms of plague, 
but the glands of the bubo form a barrier which prevents the bacilli from 
passing on and growing generally throughout the body; and it is. only 
shortly before death, in fatal cases, that this resistance is overcome and 
"Report of the Indian Plague Commission (1898-99), 1, 568. 
