300 The Philippine Journal of Science 1915 
buboes of the second order in the iliac and lumbar glands, in 
which cases massive retroperitoneal hemorrhages may be found 
about the iliac and lumbar glands, ureters, and kidneys, on one 
or both sides. Discrete punctate hemorrhages may also be 
found scattered over the parietal and visceral surfaces. These 
hzemorrhages are in some cases especially abundant in the mes- 
entery and on the inferior surface of the diaphragm. 
Reference has already been made to the extensive hzemor- 
rhages which may be found in the serosa of the sigmoid flexure 
of the colon when it lies in apposition to the peritoneum cover- 
ing primary buboes of the second order in the iliac glands. 
An acute fibrinous peritonitis may also occur in the form 
of a delicate fibrinous membrane on the peritoneum overlying 
severely affected glands, or on the serosa of the sigmoid flexure 
in those cases which present the conglomerate hemorrhages, 
to which reference has just been made. 
CARDIOVASCULAR SYSTEM 
PERICARDIUM 
Practically the only lesion found in the pericardium consists 
of hemorrhages, and these are more frequent in the peri- 
cardium than in any other serous membrane. They were noted 
in 44 of our cases. They occur much more frequently over 
the visceral (epicardial) than over the parietal surface, and 
more often over the right side of the heart than over the left. 
They seem to be most frequent and most numerous about the 
auriculo-ventricular groove on the right side posteriorly. These 
may be very few in number and small in size, or they may be 
very numerous and widely scattered over the entire heart. A 
slight excess of fluid in the pericardium was noted in 2 cases, 
but the fluid is always clear, never being turbid nor sanguineous 
(Plate III). 
HEART 
The myocardium is almost always the seat of a parenchyma- 
tous or fatty degeneration, and in some cases a Zenker’s degen- 
eration was seen, similar to that which was frequently noted 
in the skeletal muscles. Small hemorrhages in the myocardium 
were noted in a few cases. Dilatation of the right side of the 
heart is a not infrequent finding, and probably is an agonal 
event such as occurs in other acute infections. 
The endocardium in a few cases shows small hemorrhages, 
but in no case has any acute inflammatory manifestation been 
seen, nor has any reference to such an event been found in the 
literature of plague. 
