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The pathological changes found in plague may be summed up as follows:-
1. General congestion and hyperæmia.
2. Widespread hæmorrhagic extravasation.
3. Marked glandular enlargement, edema and hæmorrhage.
4. General granular degeneration of all organs and tissues.
I know of no other infective disease in man with pathological features like plague. In animals, various septic diseases produce almost identical post-mortem appearances. The pathological appearances of the tissues of persons who have succumbed to the venom of certain species of snakes, resemble somewhat those met with in plague.
Case No. 1.-An adult male Chinese, at. 25, brought to the Public Mortuary for examination. The body was found in a deserted house. The corpse was that of a'well nourished man. The skin had the cyanosed appearance met with in plague. On superficial examination, the case looked like one of small-por, vesicles and pustules being scattered over the face, shoulders, anus, body, and legs. It is not my custom to perform a necropsy on the majority of small-pox cases. They are merely examined superficially in order to determine the diagnosis. On this particular occasion, I remember that the Caretaker of the Mortuary, who has had a large experience in this line, pointed the case out to me as one of small-pox. An eruption covered the skin. Papules, vesicles, and pustules were present side by side. They were numerous over the neck, back, shoulders, back of arms, ventral surface of the abdomen, the extensor surfaces of the thigh and the buttocks.
The papules were fewest in number. They were small, never larger than a pea, raised above the general surface of the skin, and surrounded by extravasated blood.
The vesicles varied in size, they were occasionally umbelicated, apparently ran together, contained turbid serum containing a few plague bacilli and were also surrounded by a discoloured area of skin due to blood extravasation.
The pus- tules were the most numerous. They also varied much in size. One was present on the shoulder which resembled an ordinary boil. Their bacteriological contents were subject to considerable variation. Plague bacilli were found in what appeared to be the most recently formed pustules. In others, which were evidently more advanced, no plague bacilli were found, ordinary pyogenic micro-organisms being present. There was no question of small-pox.
A bubo was present in the right groin, which contained plague bacilli. Plague bacilli were also found in the heart blood and spleen.
This case was interesting from several points of view, namely
1. The bubonic nature of the case.
2. The presence of a generalised skin eruption.
3. The nature of the eruption being papular, vesicular, and pustular.
4. The presence of the B. pestis in the erupted foci.'
5. The absence of any apparent lymphatic connection between the crup-
tion and the bubɔ.
6. The likeness presented by the case to small-pox.
Case No. II-A Chinese male, æt, about 28, a coolie engaged in a godown. Post-mortem, the general appearances were those of septicemic plague. The B. pestis was found in the heart blood and spleen. A well developed bubonic swell. ing was present in the right avilla. It contained hoards of the virus. Passing from this peripherally, one found rows of small vesicles, at first along the inner side of the arm, then along the supinator longus muscle area to the wrist where they apparently ended.
No evidence was found about the hand of injury to the skin. Plague bacilli and streptococci were found in the vesicles.
This was probably a case of direct infection through the skin. Lymphangitis could not be seen. The case was not examined clinically,