555
Case No. III.—A Chinese female, æt. about 20. This case was seen during life. A bubo was present in the right axilla. No definite point of skin inoculation was discoverable but extending from the wrist to the elbow, on the flevor and extensor aspects of the forearm, numerous vesicles and pustules were found. Plague bacilli were found in many of the vesicles. The examination of the pustular contents gave negative results so far as plague bacilli are concerned. Lymphan- gitis was present in the forearin and arm, particularly along the latter.
Plague bacilli were found in the blood and bubo. The case was not examined by me post-mortem.
Case No. IV. For particulars in regard to this case. reference must be made to Case No. II under the heading of "Buboes and their Significance.”
Case No. V-A Chinese male child, aged about 10 years.
The general post mortem appearances were those usually found in plague. The B. pestis was found in the heart blood and spleen. The type of disease was septicæmic. There was no trace of a bubonic swelling. The pericardial sac to external appearance was reddened and congested. On section the parietal laver was much thickened, oedematous and extremely vascular. The sac was full of thick blood coloured fluid containing numerous solid particles which had the appearance of fibrin. Plague bacilli were found in this fluid. Other micro-organisms were present, particularly pneumococci. The inner surface of the parietal layer was rough and irregular, due to the deposition of a slight amount of fibrin. The type of inflammation was hæmorrhagic, and numerous extravasations of blood were found in the wall of the sac. The visceral layer was also thickened, particularly in patches. Patchy hæmorrhagic extravasations as well as numerous minute petechiae were found in this layer. The latter were especially well marked at the point on the heart's surface marking the interval between the auricles and ventricles, and along the course of the coronary vessels. The lungs were healthy, although very hyperamic. The mediastinal glands were enlarged and showed cortical blood extravasation. There was no periglandular effusion of blood.
Case No. VI-A Chinese male adult, aged about 30. Typical post mortem appearances were found. Plague bacilli were present in abundance.
A bubo was present in the right axilla. The pericardium was in a condition resembling more or less that found in Case No. V. There was much more fibrin formation. Plague bacilli could not be demonstrated with certainty in the pericardial fluid. Micros- copically organisins resembling the B. pestis were found, but the results of cultural experiment were negative. The organism present in greatest abundance was the pneumococcus. The mediastinal glands were enlarged and extremely hyperæinic. There was no apparent extravasation of blood. In the lungs, patchy consolidation was found, and plague bacilli were numerous.
Case No. VII.--For particulars in regard to this case, vide Case No. 1 under "Buboes and their Significance." The lymphatic glands were enlarged, ædematous and hæmorrhagic. They were embedded in extravasated blood, the latter extend- ing into the posterior mediastinum, and upwards to the cervical lymphatics at the roof of the neck. Plague bacilli were present in enormous numbers in the
mass.
The general post-
Case No. VIII-A Chinese male child, aged about 12. mortem appearances were those of septicamic plague. The lymphatic glands corresponding to ileum of the small intestine were enlarged, and hemorrhagic. They were embeded, in a mass of hæmorrhage. Plague bacilli were present in mass- es. The other glands of the inesentery were free, but enlarged, very edematous and hæmorrhagic. The glands about the coeliac plexus were also enlarged and hæmor- rhagic. The ileum was hyperemic, and "spotted" with petechiæ. membrane was studded with infiltrated solitary follicles around many of which was a zone of hæmorrhage. There was no ulceration of the mucous membrane. Peyer's patches were apparently unaffected. The remaining portions of the small intestine were normal to the unaided eye. The large intestine and rectum was normal.
Its mucous
Case No. IX.-For details, vide Case No. 1 under "Buboes and their Signi- ficance. In this case the stomach, and the small intestine in general were hyperæmic. l'etechiae were most numerous about the walls of the stomach, duodenum and ileum. There was streaky ulceration of the mucous membrane of