x,B,4 Crowell: Pathologic Anatomy of Bubonic Plague 295 
very thickly beset with punctate hemorrhages, so that no square 
centimeter of the entire surface is free from them. A type of 
plague has been described by some authors in which the intestine 
was said to form the portal of entrance for the bacilli to the body. 
In such cases primary buboes were described as occurring in the 
mesenteric glands. 
Attempts by various workers to reproduce this type of plague 
in animals by feeding cultures of the bacilli have resulted in 
primary infection through the mouth or pharynx rather than 
through the intestine. Similarly, in animals naturally infected 
by ingestion, cervical rather than mesenteric buboes occur. The 
Anglo-Indian Commission*! and the Austrian Commission ” 
agree in stating that no case was seen in which alimentary 
infection was considered probable. In my series three cases 
occurred in which plague lesions other than hemorrhages were 
present in the intestine, but in each of these there were portals 
of entry in other parts, and both the intestinal lesions and the 
slight changes in the mesenteric glands were interpreted as 
secondary infections with the plague bacilli through the blood 
stream. 
In the first case (2125) the infection apparently entered 
through the tonsil, which showed ulceration and the lesions 
described elsewhere in this paper as those characteristic of a 
primary tonsillar bubo. All of the superficial glands showed 
lesions characteristic of secondary buboes. 
In the intestine beginning with the descending portion of the 
colon, extending through the sigmoid, and most prominent in 
the rectum, were numerous small ulcers, pin-point to pinhead in 
size. These were surrounded by a narrow hyperemic zone. In 
the descending colon there were many grayish white, pinhead- 
sized, soft nodules. In the rectum the ulcers were so numerous 
as to give a hyperemic appearance to the entire mucosa. The 
mesenteric glands were red and moist, like secondary buboes. 
No other focal plague lesions were found in this body. Strepto- 
coccus pyogenes and Bacillus pestis were isolated from the 
spleen. ) 
The second case (2148) was one with left axillary bubo and a 
pseudomembranous pharyngitis and laryngitis, The mucosa of 
the intestine showed no lesions except in the rectum, where there 
were fairly numerous pinhead-sized, slightly raised, pale, soft 
foci. Some of these were surrounded by a narrow red zone. 
“ Report of the Indian Plague Commission (1898-99), 1, 368. 
“ Uber die Beulenpest in Bombay (1898), II B, 543. 
