280 The Philippine J ournal of Science 1915 
from that source of infection. Of all the buccal structures the tonsils 
seem to he most frequently the primary one attacked. In this fact we have 
only another illustration of the importance of incomplete epithelial invest- 
ment and perhaps of previous disease in promoting infection. Other parts 
of the buccal cavity may become secondary points of development of the 
bacilli. 
The Anglo-Indian Commission 7’ reports: 
The question as to whether there are channels other than the skin 
through which the plague bacillus effects an entrance into the system 
may unhesitatingly be answered in the affirmative. In favour of the view 
that the infective material may in some cases obtain access to the system 
through the mucous membranes of the nose, mouth, or pharynx, are: first, 
the fact that the infection in plague can, in animals, be experimentally 
produced by the inoculation of the plague bacillus on the mucous membrane 
of the nose; secondly, the fact that in man buboes under the chin and 
about the angle of the jaw are not uncommon; thirdly, the fact that the 
plague bacillus has been found in the human patient in association with 
primary inflammatory lesions of the tonsils and of the mucous membrane 
of the nose and the pharynx; lastly, certain epidemiological facts appear 
to speak in favour of the possibility of the bacillus entering the system 
by means of the mucous membrane of the nose, such as the fact that, in 
certain places, epidemics which have been diagnosed as epidemics of mumps 
preceded and may possibly have stood in casual [?] relation to epidemics 
of plague. Again, in one instance at least, there is, as we shall see here- 
after, reason to suspect that an epidemic of severe coryza may have stood 
in causal association with a subsequent epidemic of plague. 
Strong and Teague ** have shown that in guinea pigs cervical 
buboes sometimes may result from the inhalation of a suspension 
of virulent pest bacilli, and that local application of the bacilli 
to the tongue or pharynx of monkeys may produce cervical 
buboes. 
In human beings primary cervical buboes may also result 
from infection of the cutaneous areas drained by the cervical 
glands. 
In this series primary cervical buboes occurred 10 times. In 
2 of these cases the bubo was on the right and in one case on 
the left. In the other 7 cases it appeared to be double, or, at 
any rate, both sides were involved, and it was impossible to tell 
on which side the bubo was primary. The glands involved were 
sometimes superficial at the angle of the jaw and sometimes 
were deep prevertebral or perilaryngeal glands. The involve- 
ment of the prevertebral glands as primary buboes of the second 
order with primary axillary buboes has already been mentioned. 
There is usually much cedema associated with primary cervical 
*“ Report of the Indian Plague Commission (1898-99), 5, 71. 
* This Journal, Sec. B (1912), 7, 173. 
