264 The Philippine Journal of Science 1915 
bacilli. The corium and a superficial part of the subjacent tissue have 
undergone necrosis and are replaced by a mixture of polymorphonuclear 
leucocytes, bacilli, and nuclear fragments. The bacilli form dark blue 
masses in strands and globules. It cannot be recognized whether these 
strands are in lymphatics or blood capillaries. This infiltration extends 
slightly laterally in the corium, but not deeply. The vessels in the corium 
just surrounding this zone of infiltration are much engorged. 
The histological changes in the carbuncles differ only in degree 
from those in the papules. The necrosis and loss of tissue is 
much greater, and the zone of infiltration with leucocytes and 
bacilli extends more deeply, forming a virtual phlegmon. 
LYMPHATIC GLANDS 
Lymphangitis between the point of entry of the infective 
agent and the primary bubo does not occur. The primary bubo 
occurs in the lymphatic glands draining the area of the skin 
which forms the portal of entry of the plague bacillus. 
The Anglo-Indian Commission *! points out that the skin sur- 
faces which drain respectively into the glands of the neck, the 
axilla, and the groin stand to each other approximately as the 
figures 1:1.8:5 and that there is a striking coincidence between 
these figures and those which express the relative frequency of 
the buboes in these situations, which they found to be 1:1.3:5.8. 
When the portal of entry of the bacillus is situated in the distal 
parts of the extremities, the popliteal and cubital glands are 
seldom the seat of the primary bubo. In this disease, as in 
other similar infections, the infection passes to the groin and 
axillary glands, although no satisfactory anatomical explanation 
of this phenomenon has been offered. 
The changes occurring in the primary bubo may be very 
striking. In a well-marked case there is a visible rounded prom- 
inence over the site of the glands, which to the palpating hand 
feels boggy, elastic, and firmer than normal. Individual glands 
cannot be palpated, and it may be impossible to move the skin 
over the subjacent structures. The whole mass is indefinitely 
outlined, merging gradually into the surrounding tissue. Punc- 
tate hemorrhages may be present in the skin overlying the bubo, 
and in a very small number of cases definite pustules may have 
formed. The entire extremity, in the case of femoral or axillary 
buboes, may be cedematous as the result of pressure of the en- 
larged glands upon the vessels and as the result of lymph 
obstruction. 
* Report of the Indian Plague Commission (1898-99), 5, 70. 
