x,B,4 Crowell: Pathologic Anatomy of Bubonic Plague OM AT 
Case of primary bilateral buboes.—The following case (2131) has been 
interpreted as one of probable bilateral primary inguinal buboes, as glands 
on both sides showed the lesions of primary buboes of the first order, and 
the iliac and lumbar glands on each side showed the lesions characteristic 
of primary buboes of the second order. Filipino, male, 35 years old. 
The duration of illness was seven days (?). A single hyperzmic but not 
enlarged lymphatic gland is found in the right popliteal space. In opening 
up the right inguinal region, the subcutaneous tissues are found to be 
very moist, while just below Poupart’s ligament is the greatest swelling. 
On dissecting away the cedematous fat, a chain of enlarged lymphatic 
glands is found parallel to the ligament. These are surrounded by hzemor- 
rhagic fatty tissue. On section about four or five glands are found to be 
involved, the largest being 2 centimeters in diameter. They are hzmor- 
rhagie and spotted with numerous small, bright red areas and a few 
yellowish softened areas. The femoral glands are very slightly, if at all, 
enlarged and are rather pale. In the left inguinal region the fatty tissues 
over Poupart’s ligament are also slightly cedematous, and one enlarged 
hemorrhagic inguinal gland surrounded by hemorrhagic fatty tissue is 
found; the other inguinal and the femoral glands on the left side are- 
slightly hyperemic, but not hemorrhagic or softened. The iliac and lumbar 
glands on both sides are much enlarged and are hemorrhagic, while about 
the glands and iliac vessels there is much diffuse hemorrhage in the tissues. 
PRIMARY (7?) ILIAC BUBOES 
Extensive hemorrhagic lymphadenitis was present in the iliac 
glands in three cases (2024, 2989, 3194) in which no popliteal, 
femoral, nor inguinal bubo was recognizable at the time of 
autopsy. 
In the first case (2024)? there were also extensive changes 
in the lumbar, mesocolic, and mesenteric glands and extensive 
gastrointestinal hemorrhages. Cultures of B. pestis were ob- 
tained from the iliac glands, spleen, and lungs. The duration 
of illness in this case was not recorded. 
In the second case (2989) there was found a slightly enlarged, 
right femoral gland which was firm and red, but was without 
apparent hemorrhage. The right iliac glands were much en- 
larged, hemorrhagic, and friable, with extensive hemorrhages 
about them, extending along the lumbar region as far as the 
coeliac axis. This case had also extensive secondary pulmonary 
involvement, and the duration of illness was stated to be ten 
days. 
In the third case (3194) there was no visible change in any 
of the superficial lymphatic glands, but there was found a mass 
or chain of enlarged, very hemorrhagic glands, situated along 
the right iliac crest and in the right lumbar region to about 5 
centimeters above the bifurcation of the aorta. There was no 
* This case is reported in full on page 296. 
