x,B,4 Crowell: Pathologic Anatomy of Bubonic Plague 288 
HISTOPATHOLOGY OF THE PHARYNX AND TONSILS 
The changes that occur in the pharynx generally are of a 
character similar to those in the tonsil, and our description will 
be confined to the lesions of the latter. The conclusions that 
were arrived at as the result of the macroscopic examinations are 
completely confirmed by microscopic examination. In the cases 
in which the parotid or submaxillary lymphatic glands form the 
primary bubo, the tonsillar changes are much less severe than 
in those cases of primary femoral or axillary buboes with ton- 
sillar involvement or in the cases of so-called primary tonsillar 
buboes. In fact, a moderate grade of congestion, causing some 
swelling and reddening of the tonsils, is the only change that 
could be detected in the examination of the tonsils from the 3 
cases with parotid or submaxillary buboes. 
In the 12 other cases with tonsillar involvement, as noted ~ 
above, irrespectively of whether the primary bubo was femoral, 
axillary, or tonsillar, the changes in the tonsil are so extensive 
that it is practically impossible to follow the changes in their 
order of sequence. The most that can be done is to state the 
changes that are found, and their order of sequence will suggest 
itself by analogy. Congestion of the tonsils in these cases is 
a constant feature. In the cases which do not show severe 
changes there also appears to be some active proliferation of 
the cells in the central parts of the tonsillar follicles. In the 
later stages all of the internal architecture of the tonsils may 
be destroyed, so that the follicular arrangement, the sinuses, and 
the crypts can no longer be oriented. Smaller or larger areas 
of necrosis occur, containing nuclear fragments, a granular cell 
detritus, often many bacilli, and usually many polymorphonuclear 
leucocytes. The bacilli may be present in large masses, and just 
as abundant as in any primary bubo ina lymphatic gland. Large 
cells with large centrally placed nuclei, containing in their cyto- 
plasm bacilli and nuclear fragments, may be seen, but these are 
not frequently numerous. Polymorphonuclear leucocytes may 
be very numerous and scattered widely throughout the tonsils 
or may be localized to form abscesses. Not infrequently these 
cells and lymphocytes may be seen passing through the epithelial 
layer lining the crypts. Small hemorrhages may also occur 
throughout the tonsil. In some cases the cellular elements appear 
to be separated by spaces in which is a granular material, thus 
giving the appearance of a loose arrangement to the whole tonsil. 
This is probably a manifestation of cedema. 
Some cases have been seen in which the capsule covering the 
