266 The Philippine Journal of Science 1915 
These primarily affected glands just described constitute the 
primary bubo of the first order. 
The infection passes from these glands along the lymphatic 
channels to the next proximal glands, which in turn form the 
primary buboes of the second order. Retrograde metastases may 
occur along the lymph channels to the glands of the opposite side, 
and these glands show changes similar to the primary bubo of 
the second order. The possibility of a double primary bubo must 
be borne in mind. That this may occur cannot be doubted, and 
such cases have been recorded. In only one case (2131) of my 
series did this seem probable among the groin cases, but seven of 
the cervical buboes were bilateral, and the lesions on the two sides 
were so similar that it could not be denied that both might have 
been primary, although it seems improbable that this was so in all 
of these cases. The glands of the opposite side of the body may 
also become infected through the blood, in the same manner as 
the glands in other parts of the body, thus constituting secondary 
buboes. The changes in the primary buboes of the second order 
are similar in character to those in the primary buboes of the 
first order, but less in degree. The involvement of the glands 
and periglandular tissue in cedema, hemorrhage, and necrosis is 
less, and the glands are not as a rule matted together nor so 
much enlarged. The cedema, especially, is usually much less 
marked than about the primary bubo of the first order. 
The secondary buboes show lesions similar in character to 
those usually exhibited in an acute infection by the blood stream. 
They are slightly enlarged and much congested, but seldom show 
hemorrhage, surrounding cedema, or much necrosis. We have, 
however, encountered one case in which suppuration occurred 
in a secondary bubo. 
Table III shows the location of the primary buboes in our 
series. : 
TABLE III.—Location of buboes in 75 fatal cases. 

| 



! 
Gland. |Right.| Left. Double.) Total. | 
| Removal Gis: Sees 5 Soe eee A SS 2 31 | 24 | 1(?)) 55 
Cenyitall oni ritbey Bice upper ect Jak el eels eel ee ale | Bac coda MU Rita | 
Assillaryisce: sntcn cook the ts beet ete cect ne ee eee 2 eee 6 | 
Wige Seca eee Pec ieee hen see cee ccie ee Bh oa eee A apace 1 3 
Popliteasl cc. s =a 55< ee Soe ee eee See el i Bl eee a 1 

From this table it will be seen that cervical, axillary, and 
femoral buboes in our series occurred in the proportion of 
1:0.6:5.5, as compared with the Anglo-Indian Commission’s pro- 
portion of 1:1.3:5.8. 
