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decomposes rapidly. The kidneys are increased in size and weight. The capsule is tense. It can be easily detached. Marked capillary injection is seen shining through the capsule. The cut surface is dark red in colour. The hyperemia is most marked in the medullary portion. A condition of acute parenchymatous nephritis is frequently present. The pelvic mucous membrane shows marked capillary congestion and may show a few petechia. The ureters are thickened and often ædematous. Perechia are found in the mucous membrane. The bladder, apart from the presence of a few hæmorrhages, may be normal. In other cases the mucous membrane is hyperæmic.
The suprarenals are congested, but otherwise normal. The inale genital organs are normal. Hyperæmia and petechia are found frequently in the testicles. In buboes situated about the groin, the hæmorrhagic extravasation may extend along the vas deferens to the epididymnis and testicles. The scrotal connective tissue may also be infiltrated with extravasated blood.
The female genital organs vary in appearance and in the extent of pathological change. The appearance presented by the peritoneal surfaces of the organs is one of congestion with hæmorrhagic extravasation. Hæmorrhages between the layers of the broad ligament are common. The ovaries are congested. The graafian follicles frequently contain extravasated blood. Petechiae are found on the surface of the body of the uterus. The endometrium is congested, with frequent epithelial degeneration and hæmorrhages. Petechiae may also be found in the vaginal wall, The vulva may be the seat of a dense infiltration of extravasated blood, the condition being an extension of the condition found in a neighbouring groin bubo.
The urine is albuminous. It contains usually varying amounts of blood. Its specific gravity is low. The chlorides are diminished. Indican is usually present, and in the sediment, leucocytes, red blood corpuscles and various varieties of casts are found. The B. pestis is frequently to be found in the urine.
The pancreas is congested. Hæmorrhagic extravasations are frequent about the head of the organ. This organ rapidly decomposes in cases of plague. The peritoneum is usually moist and shiny. The cavity contains a variable amount of yellow and turbid serum. Stall petechiae may also be present. In many cases in which bubonic-like swellings are present in the mesentery and in the external iliac lymphatic gland region. The retroperitoneal glands, the ductus lymphaticus with the cysteina chyli are embedded in a soft hæmorrhagic mass. This infiltration extends in all directions, but is specially upwards to the portal vein and to the capsule of the kidneys. Further details in regard to these intra- abdominal extensions of bubonic swellings will be given under the subject of Buboes. The mesentery is a frequent site for the presence of hæmorrhages. These are often very extensive. In one or two cases, almost the entire mesentery was extravasated with blood. The folds of the mesentery are also soft, and oedema- tous. The contained lymphatic glands are enlarged and hæmorrhagic. lymphatic glands standing in relation to the ileum and coccum are always most affected. These are frequently double their ordinary size and on section are
edematous with minute blood extravasations into their parenchyma.
The
The glands may be embedded in a hard, thickened mass of hæmorrhagic and present on section areas of hamorrhage, necrosis, etc. These are typical bubonic formations. Several cases of this bubonic formation have been found. Vide Cases Nos. VIII, XI, X. The ordinary pathological appearances of the mesentery in cases of plague are fully described by WILM. My own results are more or less in harmony.
The central nervous system is generally very congested. Hæmorrhages are present throughout. In a considerable number of cases of plague in females, abortion had occurred. The fœtus and placenta was examined in every case. Plague bacilli have been found in the placenta, but never in the umbelical cord or foetus. The tissues of the latter are similary affected. Hæmorrhages are frequent. The placenta appears to present an absolute barrier to the B. pestis. The poisons produced by the organism, however, are conveyed to the foetus, calling forth in the organs of the latter, pathological changes similar to those found in ordinary cases of pest.