306 The Philippine Journal of Science 
(Edema of the gland is also a very common feature, and this 
is most noticeable between the vessels and columns of cells in the 
zona fasciculata. This may cause a considerable widening of 
the spaces between these columns of cells. Congestion of the 
cortical vessels is exceedingly common, and in a few cases the 
medullary vessels were engorged. No cellular exudate, however, 
appears to take place, although fine fibrin threads were found in 
the cortical vessels in 23 per cent of 26 adrenals examined with 
this point in view. 
Small hemorrhages may occur in the gland—more frequently 
in the cortex than in the medulla. These were found in 32 per 
cent of 26 adrenals that were carefully examined. Small hem- 
orrhages in the medulla occurred in 2 cases only. 
The changes then that were found in the adrenals consisted 
of degeneration, cedema, congestion, heemorrhage, focal necrosis, 
and fibrin thrombosis. 
ASSOCIATED LESIONS 
Osler’s seemingly paradoxical statement that persons rarely 
die of the disease with which they suffer does not apply to plague. 
Neither is plague a disease which has any predilection for those 
who have had their resistance to infection lowered by chronic 
disease. These statements probably apply with a greater degree 
of truth to plague than to any other known acute epidemic dis- 
ease. The virulence of the plague toxin and the rapidity of mul- 
tiplication of the plague bacillus are such that they do not require 
a ground already prepared in order that they may exert their 
harmful effects to the fullest extent. Scheube ** places the high- 
est age incidence of plague between the ages of 25 and 30 years. 
Reference to Table I shows that the highest age incidence in my 
series was between the ages of 15 and 40 years; in other words, 
individuals in the prime of life are most frequently attacked. 
This undoubtedly accounts for the relatively small number of 
cases of plague that show at autopsy evidence of associated lesions. 
In my series associated lesions were minimal in number. 
Chronic adhesive pleurisy heads the list with 20 cases. Evidence 
of tuberculosis (or other evidence of tuberculosis) was found 
in 5 cases. Chronic cardiac or renal disease, or both, was found 
in 5 cases only. Of uterine conditions 1 case had a myoma, 1 
was pregnant, and 1 had recently aborted. Status lymphaticus 
was found to be present in 5 cases (1894, 2084, 2086, 2124, 
2378), aged respectively 19, 14, 37, 15, and 16 years. No other 
associated lesions were found. 
* Krankheiten der warmen Lander. Gustav Fischer, Jena (1910), 267. 
