3 8o 
THOMPSON YATES LABORATORIES REPORT 
The temperature fell after the operation to 97*4°, but rose again in the evening 
to 104*2° ; death occurred on the evening of the following day. Some hours before 
death he complained of acute pain in his throat ; the tonsils and glands in the neck 
were found to be greatly swollen. Immediately after death the tissues of the neck 
became quite black. 
Post-mortem 
The post-mortem was performed by Dr. Peet (R.M.O) ; the organs were, 
unfortunately, not preserved for examination. The body showed advanced decom- 
position, and much post-mortem discoloration ; the spleen was enlarged and dark, and 
there were some soft, red, enlarged glands at the back of the pharynx and in the 
neck. There were no extravasations or ecchymoses, and the organs merely presented 
changes common to other pyrexial and specific disorders. 
Microscopical Appearance of the Glands 
At the operation about six to eight glands were removed from the groin, one or 
two of which were enlarged to the size of a walnut. The glands were soft and dark 
coloured, and the surrounding interstitial tissue was infiltrated with serum and blood. 
On section the greater part of a gland seemed to be composed of blood clot ; the 
colour was deep red, varied with a few small greyish necrotic patches, and also 
numerous small dark haemorrhagic points (engorged blood vessels). There was no 
evidence of any previous inflammation. 
These features, so unlike anything Dr. Alexander was familiar with, suggested to 
him the possibility that the swelling was a plague bubo. The idea was not then seriously 
entertained because there was nothing in the youth's history to support the diagnosis : 
he had lived all his life in Liverpool ; he was not brought into contact, either in his 
employment or in his home, with anything that might ordinarily be supposed to carry 
infection, and at that time there had been no recorded case of plague in the city. 
It may be of interest here to remark that no case of plague arose amongst his fellow- 
workers, his relations, or anyone with whom he had been brought into contact. 
Microscopical Features 
A smear preparation from the cut surface of a gland was made and stained with 
methylene blue. The film showed leucocytes, red blood corpuscles, a quantity of 
granular debris, and a few bacilli. The bacilli occurred very infrequently, and 
appeared to be fairly long and evenly stained ; there were, however, two or three 
which were short and oval, and which showed a distinct tendency to polar staining. 
