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always prominent, and sometimes even ulcerated. The liver is intensely congested, increased somewhat
in size, the tissue pale or brownish red on section, and the parenchyma, if altered at all, softened.
The gall bladder is generally found full of bile, and around it a haemorrhage may be found. The
spleen is swollen to three or four times its normal size; hyperæmia is usual, and the colour of the organ
varies from bright red to deep purple. Haemorrhage may occur beneath the capsule and extend for
some distance into the splenic pulp.
The kidneys are found enlarged, deeply congested, and occasionally embedded in a mass of
coagulated peri-renal blood. The capsule is easily removed, the stellate veins are prominent, and
small haemorrhages occur between the capsule and the kidney surface. A thickened cortex and a
cloudy swelling of the renal substance are apparent on section. Blood may occupy the renal pelvis,
and both the ureter and the bladder occasionally contain blood. The bladder may be distended with
urine or quite empty, and the mucous membrane may or may not show petechiae.
The nervous system—Meningeal congestion, engorgement of the cranial vessels, œdema, and
distinctly marked vascular puncta in the brain substance, are almost constantly met with in plague.
Ecchymoses in the pia mater occasionally occur. The spinal cord and the nerve trunks show no
pathological changes.
Septiccemic plague.
The special post-mortem characteristics of this variety of plague are confined to the state of
the glands. There are no buboes, but practically every gland in the body is swollen in some degree.
In one group and in one gland of the group adenitis is more advanced than in others, but all show
signs of engorgement on section. They are of a pink colour and firm in their consistence, although
in the largest glands areas of softening are apparent.
Congestion of viscera, subendothelial and submucous hæmorrhages and petechias occur in
the septicaemic form of plague ; but there is no periglandular effusion or haemorrhage to be found. It
would appear as though the intensity of the poison is so virulent and its diffusion so general that
the patient is carried off before the bubo had time to develope, for this is a most fatal form of plague. -
Pneumonic plague.
The pathological changes in the pneumonic variety of plague are almost wholly confined to
the respiratory organs. It is quite exceptional to find any gland enlarged, but occasionally the
bronchial glands appear swollen. The changes presented in the lungs are:—(Edema, venous engorgement,
patches of pneumonic consolidation irregularly distributed and varying in size from a hazel
nut to a good-size apple. Around the reddish-grey or claret coloured patches a circle of crepitant
and engorged lung tissue exists. Subpleural haemorrhages are usual. The bronchial, the tracheal and
laryngeal linings are reddened and injected; a frothy, blood-stained fluid occasionally occupies
their lumen. The cerebral, the cardiac and abdominal changes resemble those mentioned as occurring
in bubonic plague.
James Cantlie, M.B., F.R.C.S.,
Lecturer, London School of Tropical Medicine.