x, B,4 Crowell: Pathologic Anatomy of Bubonic Plague 3801 
Chronic inflammatory lesions of the endocardium and myo- 
cardium have been found in a few cases, but these were indu- 
bitably due to preéxisting disease. 
The vessels show no macroscopic lesions attributable to the 
plague infection other than the presence of hemorrhages from 
them which are due to microscopic lesions, which will be de- 
scribed with the histology. The presence of hemorrhagic in- 
filtration of the walls of the larger vessels in the immediate 
vicinity of the primary bubo is very frequent and has been 
especially noted by the Austrian Commission, who conclude that 
this may form a portal for the direct passage of the bacilli 
from the primary bubo to the blood stream in the veins. 
HISTOPATHOLOGY OF THE HEART 
The myocardium constantly shows evidence of acute paren- 
chymatous degeneration, with a marked swelling of the fibers. . 
Small hemorrhages beneath the epicardium have been noted as 
of very frequent occurrence. Congestion of the smaller vessels 
between the muscle bundles is frequently a prominent feature, 
and it is not unusual to see small hemorrhages separating the 
muscle fibers. Cellular exudate from the vessels does not occur. 
(Hidema may be marked and widespread, causing wide separation 
of the muscle fibers. 
The muscle fibers often show marked vacuolation, but seldom 
fatty change. Some of the muscle fibers become opaque, and 
the striation, especially the cross striation, becomes very in- 
distinct. Transverse clefts and even complete fragmentation of 
the fibers is often seen. This homogeneity of the fibers, with 
the breaking up into small fragments, is apparently a Zenker’s 
hyaline degeneration of the muscle fibers. Such a degeneration 
was frequently noted in the macroscopic examination. Bacilli 
may be found within the vessels and are particularly numerous 
in the vicinity of the hemorrhages. 
NERVOUS SYSTEM 
Meningitis in plague has been reported by the Austrian ** and 
German ** plague commissions and by Calmette and Selembini *°. 
Two noteworthy cases have occurred in my series. 
The first case (2431) was a 19-year-old female Filipino, who had been 
ill for two weeks. The anatomic diagnosis was bubonic plague; acute 
suppurative lymphadenitis (primary bubo), right axillary; acute suppu- . 
* Uber die Beulenpest in Bombay (1898), II B, 287. 
“Arb. a. d. kais. Gesundheitsamte (1899), 16, 101. 
® Ann. Inst. Pasteur (1899), 13, 865. 
