256 The Philippine Journal of Science 1915 
the bacilli are able to pass on into the system generally. But in the 
septicemic form the bacillus, after entering the body, meets with feeble 
resistance at the nearest glands; it speedily overcomes all opposition and 
passes on to infect other glands and organs where it grows abundantly. 
The Austrian Commission also recognizes this type of the 
disease, which it calls septicopyzemic. 
Concerning primary plague septicemia, the German Commis- 
sion § reports: 
Primary plague septicemia probably does not exist. At least our own 
Commission as well as the Austrian one, and other investigators, have 
found on post-mortem examination, in such cases in which the portal of 
entrance of the virus could not be ascertained, small hemorrhagic glandular 
foci, or a focus in the lung. These had in consequence of the indifference 
of the patients, or in consequence of their occult location, escaped notice 
during life. Hence plague septicemia is not a special type of the disease, 
but the generalization of a primarily local process. That it may then again 
lead to other secondary internal foci we have demonstrated in a case of 
plague meningitis. 
Strong and Teague, who had the opportunity of studying the 
epidemic of primary pneumonic plague, reached the following 
conclusion in regard to primary plague septicemia: 
From our studies made upon human beings, during the Manchurian 
epidemic, as well as from the animal experiments quoted above, we must 
conclude that primary plague septicemia does sometimes take place and 
that death may occur, though rarely, before visible lesions have taken place 
either in the lungs or lymphatic glands. 
Herzog '° opposed the classification of plague in man as a 
general hemorrhagic septicemia. This conclusion he bases on 
“the fact that all observations made on man show that the plague 
bacillus is not present at all early in the course of the disease in 
the general blood circulation,” and further on the fact that 
“histologic examinations have further demonstrated that as a 
rule plague bacilli are either found not at all in the vascular 
system or are present in such very small numbers that an agonal 
or post-mortem invasion suggests itself.” 
Herzog’s classification of plague is as follows: 
(1) Primary uncomplicated bubonic plague; (2) primary bubonic plague 
with secondary septico-pyemia; (8) primary bubonic plague with secondary 
plague pneumonia; (4) primary plague pneumonia; (5) primary plague 
pneumonia with secondary septico-pyemia; (6) primary plague septicemia. 
In regard to the presence of B. pestis in the circulating blood 
‘Arb. a. d. kais. Gesundheitsamte (1899), 16, 75. 
* This Journal, Sec. B (1912), 7, 180. 
* Pub. Bur. Govt. Labs., Manila (1904), No. 23, 20. 
