x, B,4 Crowell: Pathologic Anatomy of Bubonic Plague 281 
buboes, this extending into the loose tissues about the pharynx. 
As a result 8 of the 10 cases with primary cervical buboes showed 
lesions of the pharynx, varying from a simple ceedema up to a 
very marked pseudomembranous pharyngitis and tonsillitis. 
There seemed to be no method of determining after death, in an 
individual case, whether or not the glandular involvement was 
consequent upon primary pharyngeal infection. Careful inves- 
tigation of the course of events in clinical and experimental cases 
alone will determine the sequence, and such experience by Strong 
and Teague has been referred to above. 
Our observation that severe pharyngeal lesions, amounting 
even to a severe grade of tonsillitis, may be secondary to primary 
axillary buboes suggests that the pharyngeal lesions may also 
be secondary to cervical buboes when the portal of entry of the 
infection is on the cutaneous surface. Similar observations were 
made by the Austrian Commission. 
Table IV shows the relation, in this series, of the cervical bu- 
boes, pharyngeal lesions, and focal pulmonary plague lesions. 
TABLE I1V.—Association of cervical glandular, pharyngeal, and pulmonary 




lesions. 
| ; Associated lesions. 
ne 2 \Num- ‘ 
| Cas eo WBE ber. | Cervical | Pharyn- ea None of 
| buboes. geal nary preced- 
| lesions. lesions: ing. 
Cervical buboes 05.02 s- 2 ts ee eee eae 10! | Rea 8 | 6 
iPharyngeallesionsys-= 342 oee se o.8 ee eee 11 (2) tee eee | 7 1 
Hocallpulmonarvalesions=o. 2 se. enn ae ee 13 6 G) | See ees 5 








The relation shown in the table between the cervical buboes 
and the pharyngeal lesions has already been discussed. The table 
shows that, of our 10 cases with cervical buboes, 6 had focal 
plague pulmonary lesions, and that 5 of the 13 cases with focal 
plague pulmonary lesions had neither cervical buboes nor pha- 
ryngeal lesions. An explanation of these will be offered in the 
part of this article dealing with pulmonary lesions. 
PHARYNX AND TONSILS 
The lesions of the pharynx should receive consideration in 
close association with the cervical buboes. 
Pathologic conditions of the pharynx are of frequent occur- 
rence in plague. There may be a simple cedema of one part of 
the pharyngeal wall, or the entire wall may be very much swollen 
and show various grades of necrosis, hemorrhage, and ulceration. 
133736 3 3 

