x,B,4 Crowell: Pathologic Anatomy of Bubonic Plague 265 
On section into a primary bubo there will be found a dense 
subcutaneous tissue which typically exudes a large amount of 
clear yellowish fluid. A mass of glands will be found which 
are enlarged sometimes to as much as 5 centimeters in diameter. 
These glands are conglomerate and hemorrhagic, as is also the 
periglandular areolar tissue, thus making the outlines of the 
glands indistinct. In the early stages the glands are firm and 
red, while in the later stages they become softened and show 
yellowish areas. One or several glands may be involved in this 
mass, and the amount and extent of the ceedema and hemorrhage 
varies in different cases. Most frequently there are several 
glands involved, and the tissues surrounding the glands are also 
very hemorrhagic and cdematous, this condition involving 
muscles, vessel walls, and fasciz (Plate V). Extension along 
fascial planes may also be a marked feature, as in groin cases, 
down Hunter’s canal, and, in axillary cases, up into the neck. | 
The infiltration of the subcutaneous areolar tissue between the 
bubo and the skin may be so dense as to make this tissue almost 
of cartilaginous consistence. 
While this description applies to a well-marked case, the 
changes may be of a much slighter grade, the primarily affected 
glands being small and showing very little intra- or extra- 
glandular hzemorrhage, cedema, or necrosis. In some cases the 
primary bubo consists only of a single gland with relatively 
slight changes. It is maintained by the Anglo-Indian Commis- 
sion that this is the type of disease in which an early septicaemia 
occurs, the bacteria not being held back by the lymphatic glands. 
The Austrian Commission demonstrated that true suppuration 
may occur in the primary bubo from the action of the plague 
bacillus. In my series are instances of suppuration in the 
primary bubo and in the meninges, in which the plague bacillus 
was the only infective agent demonstrable. 
Schobl ?? says: 
It can be seen from the table that the plague bacilli may not be detected 
in the enlarged gland at first and that their presence may be revealed only 
after repeated examination of the bubo. It is also evident from the results 
of repeated examinations that the plague bacilli disappear from the infected 
gland in a comparatively short time, as a rule at the time when pus starts 
to form. Contrary to the findings in patients who died, distinct phagocytosis 
was noticed in the smears made from the aspirated liquid in those patients 
who recovered and who had been treated with serum soon after the onset 
of the disease. It is undoubtedly this process that clears the gland of the 
infectious agents. 
“2 1UOOs) CE, TOs ALIAS 
133736 2 

