302 The Philippine Journal of Science 1915 
rative ependymitis; acute leptomeningitis; acute parenchymatous degenera- 
tion of kidneys, liver, and myocardium; chronic fibrous pleurisy, left; 
pregnancy, sixth month. The description of the brain is as follows: The 
cerebral leptomeninges contain a slight excess of fiuid which appears. 
slightly turbid. On opening the right lateral ventricle, it is found to 
contain a considerable amount of yellowish gray pus. The choroid plexus 
is large and soft. The left choroid is smaller, but also surrounded by 
grayish exudate. The fourth ventricle is apparently free. The brain 
substance is pale and shows nothing abnormal. 
In smears from the spleen, glands, and pus from the axilla no bacteria 
were found. Smears from the pus of the ventricle were loaded with 
plump bacilli, which varied greatly in size but did not show altogether 
typical bipolar staining. Agar cultures from the spleen showed a few 
colonies which proved to be plague. Agar cultures from the ventricles 
showed an abundant growth of plague bacilli; a guinea pig inoculated 
cutaneously with this culture died in five days with typical lesions of plague. 
The second case (3247) was an 18-year-old male Filipino, who was 
said to have been ill for one month. This case had cervical retropharyngeal 
buboes, bronchopneumonia, acute suppurative meningitis, acute parenchy- 
matous degeneration of the viscera, acute splenitis, and trichuriasis. 
The meninges over the hemispheres are dry, and the convyolutions are 
flattened. At the base of the brain, about the circle of Willis and ventral 
to the pons, is found considerable greenish yellow pus. The lateral ventricles 
contain a turbid, slightly greenish fluid, mixed with a thick, stringy, green- 
ish yellow pus, which is adherent to the floor of the ventricles, especially 
at the region of the choroid plexus, which is completely enveloped in the 
exudate. The floors of the ventricles are thickly covered by this shaggy 
mass. The third and fourth ventricles contain a slightly turbid fluid. 
Bacillus pestis was recovered in cultures from the exudate from the 
ventricles, and a guinea pig vaccinated with the culture died with typical 
plague lesions. 
Aside from these cases of frank meningitis, the meningeal 
vessels in almost all cases examined showed a congestion, and 
in some cases the brain substance showed some cedema. No 
other lesions were found. 
URINARY SYSTEM 
The kidneys in plague invariably show evidence of an acute 
parenchymatous degeneration, the renal parenchyma being swol- 
len and opaque, with relatively broad and bulging cortex. The 
pyramids are sometimes paler, with bluish red peripheries, and 
sometimes they are intensely red. In some cases the swelling, 
opacity, grayness, and friability of the cortex is so marked as 
to justify the macroscopic diagnosis of necrosis of the kidney. 
Hemorrhages in the capsule, in the mucosa of the calices and 
pyramids, and in the renal parenchyma are frequent. The renal 
capsule may be studded with punctate hemorrhages. In the 
pelvic mucosa the hemorrhages may be punctate or massive so 
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