972 The Philippine Journal of Science 1916 
Aside from the dilatation of the right heart there is no change except in 
the musculature, which is pale, rather dry, fairly firm, and somewhat 
glistening on a smooth cut surface. The endocardium shows no change. 
The base of the aorta is free. 
The spleen is enlarged to about one and a half times its normal size. 
The capsule is rather loose and is steel-blue. On the superior surface, 
through the capsule near the left extremity, a pale, yellowish white area 
about 7 millimeters in diameter is visible. Two or three similar, pinhead- 
sized areas are also visible through the capsule. On section the organ is 
rather soft and the cut surface is of a pale brown color, the lymphoid and 
interstitial elements being obscured. Section through the pale areas men- 
tioned shows definite abscess formation, the contents being soft and 
grumous. 
The adrenals are small and rather thin, the adrenal medulla being 
scarcely visible. 
The kidneys are of about normal size. The capsule strips with slight 
difficulty; the exposed surface is slightly roughened and pale red. A few 
pinhead-sized, white foci are visible on the surface. On section the con- 
sistence is somewhat diminished. The cortices are rather broad, and the 
glomeruli are fairly prominent. The vascular strie are indistinct. The 
parenchyma is pale, soft, and bulging. The pyramids are bluish at their 
peripheries and paler at their apices. The ureters and urinary bladder 
are intact. 
The mesenteric lymph nodes are not enlarged. The mesentery contains 
a moderate amount of fat. 
The gall bladder and bile ducts are normal. 
The liver is considerably enlarged, and the capsule is smooth, thin, and 
transparent. Through the capsule are visible numerous pinhead-sized, pale, 
yellowish white areas. On section into the liver the consistence is about 
normal. The cut surface presents numerous small, circumscribed, rather 
soft, pinhead-sized areas and a few larger areas about 1 centimeter in 
diameter, yellowish white, rather definitely circumscribed, with softened 
centers and pale peripheries, surrounded by a red zone. The remaining 
liver is of a brownish red appearance, the central parts of the lobules being 
darker than the peripheries. 
The stomach and pancreas are normal in appearance. 
The lumbar, retroperitoneal, cervical, axillary, epitrochlear, and popliteal 
lymph nodes are not enlarged. 
It is impossible to say from the anatomical findings where the primary 
bubo was situated, but from the clinical history the right inguinal would 
seem to be the glands first affected. The corresponding lumbar glands, 
however, showed no macroscopic lesions such as would be expected in buboes 
of the second order. 
Anatomic diagnosis.—Plague septicemia; acute inguinal lymphadenitis, 
bilateral; multiple abscesses of lungs, liver, spleen, and kidneys; acute 
parenchymatous degeneration of heart, liver, and kidneys; dilatation of 
right heart; chronic adhesive pleurisy, localized; cutaneous vesicles. 
Report on bacteriological examination of specimen taken from this case 
two days before death. Furnished by Doctor Schoébl, of the Bureau of 
Science. 
The right femoral bubo is aspirated. 
