x,B,4 Crowell: Pathologic Anatomy of Bubonic Plague 267 
HISTOPATHOLOGY OF THE LYMPHATIC GLANDS 
To trace the morphological changes in the glands from the 
beginning of the disease to its advanced stage requires a study 
of many glands in different stages of the disease. As the 
primary buboes of the second order are infected through the 
lymphatics and show lesions slighter in degree than those in 
the primary buboes of the first order, but similar in character, 
they form the best material for the study of the earlier changes. 
The lesion in the glands is essentially a hemorrhagic inflam- 
mation with coagulation necrosis. In the early stages the plague 
bacilli are present in large numbers and are situated in masses, 
chiefly in the peripheral perifollicular lymph sinuses. Early 
there occurs what is practically a “catarrh” of the lymph sinuses. 
The endothelial cells lining them enlarge and multiply, and 
many are found lying free in the sinuses intermingled with red 
blood cells and a granular material. The sinuses are dilated, - 
apparently from edema. At the same time cedema of the gland 
causes it to assume a much looser and more open arrangement of 
its constituent parts, losing its follicular arrangement. 
Extreme congestion of the blood vessels is an early event, 
and changes in the vessel walls appear. They become swollen 
and lose their normal appearance, becoming more homogeneous 
and fibrillar in appearance, Small clefts appear in the vessel 
walls, and the nuclei fail to stain with hemotoxylin. This ap- 
pearance is very similar to an cedematous hyaline change. The 
lining endothelial cells of the vessels become swollen and are 
often separated from the basement membrane by small spaces. 
Fibrin appears at the periphery of the lumen and may be seen 
in some of the spaces in the vessel wall and, later, in the tissues 
immediately about the vessels. In some cases this fibrin net- 
work completely occludes the lumen of the vessel, but its peri- 
pheral arrangement is much more frequently seen. In the later 
stages the vessels may be very much dilated; their walls are 
thin, and the lumen may be filled up with polymorphonuclear 
and mononuclear leucocytes, erythrocytes, and fibrin. Bacilli 
are also frequently found in these thrombi in the late stages. 
The blood passes from the vessels into the surrounding tissue, 
and the gland is so much enlarged and so hemorrhagic that the 
scattered remains of the original adenoid structure are difficult 
of recognition. They appear as small masses of lymphocytes 
amid the masses of blood cells and bacteria. Necrosis of the 
adenoid elements occurs and is represented by masses of granular 
material containing chromatin fragments. The trabecule of the 
gland undergo a change similar to that of the vessel walls; they 
