x,B,4 Crowell: Pathologic Anatomy of Bubonic Plague 291 
of dark color in a case of known plague, the diagnosis of mixed 
or secondary infection was ventured before bacteriological 
examination and was later confirmed. That it is possible to do 
this is shown by the fact that this was an independent observation 
of mine, and it is only recently that I have found that this 
observation was also made by the Austrian Commission. 
CASES OF SPLENIC INFARCTS 
Cases 2079.—Filipino, male, 34 years old. The duration of illness was 
five days. The anatomic diagnosis was as follows: Bubonic plague; acute 
femoral lymphadenitis, right (primary bubo); acute iliac and lumbar 
lymphadenitis (primary bubo of the second order); acute lymphadenitis, 
left femoral and axillary (secondary buboes); double hydrothorax; con- 
gestion, cedema, and atelectasis of lungs; epicardial, endocardial, pleural, 
gastric, renal, peritoneal, and splenic ecchymoses; congestion and degen- 
eration of kidneys and liver; acute splenitis; infarcts of spleen; tri- 
churiasis. Very numerous plague bacilli were found in the buboes and 
spleen. The description of the spleen is as follows: The spleen is con- ~ 
siderably enlarged, measuring 15 by 11.5 by 6 centimeters. The capsule 
is steel-blue and tense. On section the organ is firm and deep red, the 
cut surface being smooth and showing numerous minute hemorrhages 
scattered throughout the pulp. The lymphoid tissue is not visible. There 
is a small, wedge-shaped, peripherally placed, yellow, somewhat softened 
area. 
Case 2993.—Chinese, male, 35 years old. The duration of illness was 
three days. The anatomic diagnosis was as follows: Bubonic plague; acute 
hemorrhagic lymphadenitis (left lower cervical); acute pustular and 
vesicular dermatitis (plague carbuncle) ; acute hemorrhagic lymphadenitis 
(right upper cervical) ; acute pseudomembranous tonsillitis; acute splenitis; 
infarcts of spleen and liver; petechial hemorrhages in epicardium; con- 
gestion and oedema of lungs. The description of the spleen is as follows: 
The spleen is enlarged to about twice or three times its normal size and 
is very friable. The cut surface is moist, uneven, and deep red but not 
dark. The Malpighian bodies and the trabecule are obscured by the soft 
swollen pulp. On the surface are seen a few small grayish areas from 
2 to 8 millimeters in diameter. They consist of opaque friable tissue. 
See also the report of the spleen in case 1969 (page 270). 
HISTOPATHOLOGY OF THE SPLEEN 
Extreme engorgement of the spleen with red blood cells is 
the most striking feature. On account of the structure of the 
splenic sinuses it is difficult to recognize small hemorrhages 
histologically, but in bubonic plague the presence of large areas 
in which nothing but erythrocytes are visible, even in very thin 
sections, leaves no doubt in the mind that actual hemorrhage 
has occurred. Such hemorrhages, either at the periphery of the 
spleen or in its central part, are an almost constant feature of 
this disease. The erythrocytes are found in all stages of dis- 
solution. The endothelial cells lining the sinuses become en- 
