260 The Philippine Journal of Science 1915 
usually, if not always, enter the circulating blood, and other 
lymphatic glands throughout the body become infected. These 
glands, infected through the circulating blood, are known as 
secondary buboes. 
The other parts of the body suffer degenerative changes as 
the result of the action of the bacteria, of their endotoxins, and 
of the resultant fever. 
The action of the bacilli is particularly severe on the walls of 
the blood vessels, which accounts for the widespread hzemor- 
rhages which take place. 
Focal lesions in different portions of the body occur as the 
result of bacillary emboli; in this way are produced areas of 
necrosis, focal or larger, in the spleen, liver, and kidneys, and 
pneumonic foci in the lungs. Extensive cutaneous lesions may 
also be thus produced. Meningitis occurs in a small percentage 
of the cases. 
A septicemia probably occurs at some stage of the disease in 
the majority of the cases and certainly before death in all fatal 
cases. 
In bubonic plague, as well as in other acute bacterial infections, 
the infective agent may produce its most injurious effects some- 
times in one part of the body and sometimes in another; and 
according to the parts most seriously affected, there may be 
distinguished several subtypes of the disease. These have al- 
ready been referred to under the head of Classification. 
PORTAL OF ENTRANCE OF THE INFECTIVE AGENT 
Entrance occurs most frequently on the skin and less fre- 
quently on the mucous membranes. 
Dieudonné and Otto ™ say: 
In bubonic plague the portal of entry for the plague bacillus is chiefly 
the skin. In practice it is usually very difficult to find this portal of 
entry. In the majority of cases small abrasions of the skin, flea-bites, 
and insignificant scratch wounds evidently suffice to furnish the bacteria 
an entrance; indeed even intensive rubbing the skin with fingers or clothes 
to which pest bacilli are adherent is sufficient to produce an infection. Since 
the flea while sucking regularly deposits feces, it is very possible that by 
scratching the place the pest bacilli present in the feces of the flea may 
be rubbed into the small wounds in the skin. 
Dieudonné and Otto’s statement that in practice it is usually 
very difficult to find the portal of entry has been corroborated 
by my experience. In the majority of the cases at autopsy no 
“ Kolle und Wassermann, Handbuch der pathogenen Mikroorganismen. 
Gustay Fischer, Jena (1912), 4, 207. 
