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The appearance of the stomach in cases of plague has been admirably given by Captain JAMES, I. M. S., in a Report on Plague, published in 1897. I agree with the statements made, that in certain cases, the appearance of the mucous membrane of this viscus may approach that of the rash seen on the skin in a severe case of purpura.
The condition of the small intestine is similar to that found in the stomach. The changes met with are more severe. (Edema of certain parts is extreme, and petechial hæmorrhages are also found, particularly about the ileum. These are formed in connection with blood extravasations. They vary much in size. They are irregular in shape and apparently occasionally coalesce. They do not penetrate deeply. The early stages of these ulcers are represented by small areas of necroses in the mucous membrane. Such seem to slough and leave an excavated surface.
In many cases the areas of necrotic mucous membrane, which may be pin head in size, may be present without actual ulceration.
Again other cases are inet with in which there is nothing present beyond extreme hyperæmia and numerous petechiæ.
Pyer's patches and the solitary follicles also participate in the changes. These elements are swollen and may be hæmorrhagic. In the region of Bauhini's valve the intestinal changes are usually most marked. The solitary follicles are swollen, look like granules of sago, with a deeply pigmented centre.
Apart from the condition of the mucous membrane the appearance of the peri- toneal surface of the intestines is that of hyperæmia. The colour varies from a bright red to a dark reddish blue.
The various coats of the intestine are thickened, soft, and often ædematous, Beautifully marked capillary injection is seen through the peritoneal lining, passing towards the mesentery.
The contents of the intestine are soft and bile stained. They are very tenacious, and stick firmly to the mucous membrane. They may be blood stained and tarry looking. The microscopical examination of several parts of
There is evidence of inflammatory
the small intestine has been undertaken.
change extending through the wall of the gut.
The condition of the cœcum resembles that of the ileum.
In the large intestine the changes are less severe, occasionally large flat subserrous hæmorrhages are found.
The liver is increased in size and weight. Its consistence is firm and capsule is stretched and shows the congested parenchyma shining through it. Hæmorrhages are occasionally met with in the capsule. Ou section the organ drips with blood. The general colour of the cut surface is dark red, and frequently after thorough washing, small greyish-white areas can be seen. These are soft, and never much larger than a pea. Occasionally they are hæmorrhagic. Extravasations of blood, small and large, may be found scattered about the organ. These grey foci have been examined microscopically. These areas are found chiefly in the portal vein zone of the lobule. They are composed of necrotic tissue and in many cases, bacilli, identical with plague bacilli, were found lying in the debris. That plague bacilli are actually found in the situations has been accurately determined by cultural methods. The condition resembles that found in the liver in cases of enteric fever. Hæmorrhages may be found in the coronary ligament,
The gall bladder is usually distended with bile. The walls are thickened, soft, and edematous and small blood extravasations are seen shining through the wall. The bile is thick and very tenacious. Plague bacilli have been isolated in pure culture from this viscus,
The spleen is almost always congested. On section blood flows freely from the cut surfaces. Plague bacilli are demonstrable in all cases. Little can be said as regards the size and general structure of the organ, owing to the almost constant presence of changes referrable to other causes, e g., malaria, beri-beri, etc. In what may be regarded as spleens of normal size, the pulp is soft. The follicles are usually plainly marked. Hæmorrhages of ranging size are often found beneath the capsule and into the parenchyma. Infarcted areas have also been seen. The parenchyma