IQA The Philippine Journal of Science 1915 
lateral and posterior portions of the tonsil has been infiltrated 
in the same way as the tonsil itself, the cedema, hemorrhage, 
and cellular exudate passing for a short distance into the sur- 
rounding tissue. 
In regard to the epithelium covering the tonsil, sections in 
some cases may show little, if any, change, even when the tonsil 
beneath is the seat of severe changes. On the other hand, there 
may be all grades of infiltration of the epithelium leading to 
complete necrosis and the formation of a pseudomembrane. This 
pseudomembrane is made up of necrotic epithelial cells, mucus, 
leucocytes, red blood cells, fibrin, cellular detritus, and bacteria. 
Similar masses of granular detritus, bacteria, and leucocytes 
may be found with the crypts. In cases of less severity the 
epithelium covering the tonsil may show a simple vacuolation 
with small collections of bacteria and leucocytes contained within 
small clefts in the epithelial layer. A not unusual finding is the 
presence of large masses of bacilli filling a zone immediately be- 
low the epithelium covering the tonsil and surrounding pharynx. 
It will thus be seen that these changes in the tonsil are remark- 
ably similar to those occurring in a primary lymphatic bubo. 
The tonsil seldom, if ever, reaches the size of the average lym- 
phatic bubo, but this may be accounted for by the fact of its 
superficial position and the ease with which the exudate may pass 
on to the surface. 
Attention is here again drawn to the fact that such pharyngeal 
or tonsillar lesions may occur without specific pulmonary in- 
volvement. Therefore the sputum may be infective not only in 
primary bubonic cases with secondary pulmonary involvement, 
but also in cases with specific pharyngeal lesions. 
RESPIRATORY SYSTEM 
LUNGS 
Secondary plague lesions occur in the lungs in bubonic plague, 
and such cases should be distinguished from primary pneumonic 
plague cases. In the latter class of cases the infection is primary 
in the respiratory tract, and the pulmonary lesions produced 
differ very essentially from those that may occur in the course 
of bubonic plague. 
According to earlier studies by Strong, Crowell, and Teague *°: 
it would appear that epidemic plague pneumonia results from 
inhalation, the primary point of infection being the bronchi. * * * [In 
the lungs] The bacilli rapidly multiply and produce at first pneumonic 
“This Journal, Sec. B (1912), 7, 220. 
