x,B,4 Crowell: Pathologic Anatomy of Bubonic Plague 271 
tion of the skin, which looks like a large ruptured vesicle. This was 
excised for histological examination. There is marked rigor mortis and 
no external cdema. Slight post-mortem hypostasis is present. 
In both femoral regions are marked rounded prominences. Other su- 
perficial nodes are not enlarged. On section into the femoral regions the 
lymph nodes are found somewhat enlarged but discrete. There is little 
or no edema of the tissues surrounding these lymph nodes, and neither 
the nodes nor surrounding tissue are hemorrhagic. On the right side 
one lymph node measures 2 centimeters in diameter and the others are 
somewhat smaller. On section into these nodes they are somewhat softened, 
rather pale, and show yellowish white centers which appear softer than 
the peripheries. 
On body section there is a moderate amount of subcutaneous fat. The 
abdominal cavity is free from adhesions and contains but a small amount 
of fluid. The liver reaches 4 centimeters below the right costal margin. 
The diaphragm is at the lower border of the fourth rib on the right and 
the fifth rib on the left. 
The thorax. Tissues of the superior and anterior mediastinum are dry 
and pale. The left lung is adherent at its extreme apex by rather firm, - 
fibrous adhesions. The precordial area is rather small and is covered 
with fat. The organs of the neck and thorax were removed en masse. 
The lingual tonsils are rather prominent. Faucial tonsils are small and 
pale, but show no lesions. The pharynx and csophagus are normal. The 
larynx and trachea are pale. The trachea appears rather broad, and in 
its upper portion near the bifurcation is a gelatinous strand of mucus, 
which can be pulled out from the large bronchi, forming practically a cast. 
There is no congestion of the larynx or trachea. The cervical lymph nodes 
are not enlarged and are pale. The thyroid is small, rather firm, and of 
a deep brown color. 
The lungs are voluminous, and the pleura over them is thin. Both lungs 
show practically identically the same picture. They are completely filled 
with nodules, which are firm on palpation through the uncut lung. The 
nodules average about 1 centimeter in diameter and are uniformly dis- 
tributed throughout the whole lung, being separated from one another by 
spaces never more than 1 centimeter in width. Through the pleura, in 
numerous places, superficially placed nodules appear in the form of discrete 
and conglomerate yellowish white masses. On section the lung cuts with 
considerable resistance. There is one old pleural scar at the left apex. 
The cut surface of the lung is red and moist and presents very numerous 
nodules varying in size from a few millimeters to 1.5 centimeters. 
These are rather firm on palpation, grayish white, not distinctly cir- 
cumscribed, and their centers are somewhat softened, so that purulent or 
necrotic material can be scraped from their centers by the knife. The 
intervening lung tissue is deep red and shows some of the smaller nodules. 
Some of the larger nodules have immediately adjacent to them smaller 
nodules, giving them an irregular outline. There is no definite cavity 
formation anywhere, and no fibrosis of the lung and no calcification. One 
large lymph node at the bifurcation of the trachea is anthracotic, somewhat 
soft, and rather hemorrhagic. The other peribronchial lymph nodes appear 
normal. 
The heart. The pericardium is free and contains a normal amount of 
clear fluid. There are no ecchymoses. The heart is rather large, the right 
side being dilated but flabby. The blood is dark and but slightly coagulated. 
