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# IL-PATHOLOGICAL ANATOMY.
The material from which the following account is derived consisted of 867 bodies.
In 20 of these, the head, thorax, and abdomen were all opened; in 150 the thorax and abdomen only; while in the remainder the buboes merely were incised, or the abdomen opened, in order to confirm the diagnosis.
The bodies did not as a rule show any considerable degree of emaciation. There was no marked tendency to decomposition. The expression of the countenance was calm. Rigor mortis was moderate in degree.
In the skin, petechiae were sometimes found, and carbuncular swelling up to the size of a crown piece. When the carbuncles were incised, the cutis was found to be thick, hard and dense, and the subcutaneous tissue the seat of hemorrhagic infiltration.
The cerebral membranes were always congested, and the sinuses filled with dark-red blood. The pia mater was oedematous; and in most cases was clouded, especially along the vessels, by a grey, gelatinous exudation. Small ecchymoses were scattered here and there in the pia mater.
The brain-substance showed often moderate edema and numerous puncta vasculosa. The cerebral ventricles sometimes contained a small quantity of fluid.
In the pleura, there was as a rule no change. In rare cases small haemorrhages were seen in the membrane, with a moderate effusion into the pleural cavity. In most of the cases in which these appearances were found there were large axillary buboes on the affected side, with haemorrhagic infiltration of the surrounding connective tissue. In one case, as the sequel of a pulmonary abscess, there was found a large purulent effusion in the left pleural cavity.
The mediastinal glands were sometimes enlarged up to the size of a bean, and of a blue or bluish-red colour. In one case, in the mediastinal connective tissue behind the sternum, there was an abscess of the size of a hazel-nut.
The lungs were as a rule much congested and oedematous, the lower lobes especially so. From the cut surfaces, frothy red fluid could be squeezed. In 170 autopsies there was one example of abscess in the left lung; and in five cases pneumonic infiltration was found in the lower lobes. The bronchi and the larynx usually showed no morbid change, except that the mucous membrane sometimes appeared red or slightly cyanotic, and was frequently covered with mucus. The bronchial glands were often moderately enlarged up to the size of a bean, and of a red or bluish-red colour.
The pericardium, especially the visceral layer, showed frequently petechiae or ecchymoses. Fibrinous pericardial exudation was observed in one case. In no case was any considerable increase in the quantity of pericardial fluid met with. The heart, especially the right side, was always somewhat distended with blood. The heart-muscle was in most cases pale and flabby, the parenchyma cloudy or in a state of fatty degeneration. The blood in the cavities was of a dark-red colour, and was either coagulated to form soft clots, or in a semi-fluid state.
The great venous trunks of the thorax and abdomen were distended with dark-red blood. In the omentum and peritoneum and beneath them, small or large extravasations of blood were frequently met with.
The spleen was always enlarged, often from two to four times its normal size. Its consistence was sometimes soft, sometimes hard. It was usually hyperaemic, and of a bluish-red colour. Haemorrhages were sometimes to be seen in the parenchyma immediately beneath the capsule. On the surface numerous small, white, overgrown follicles were visible.
The kidneys were usually enlarged, much congested, of a dark-violet colour, and frequently showed small ecchymoses on the surface. The stellate veins were plainly visible. The cortical substance was often thickened, the parenchyma cloudy or in a state of fatty degeneration. The mucous membrane of the renal pelvis very often showed numerous small haemorrhages. The pelvis often contained small coagula, which extended into the ureters.
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The peri-renal connective tissue frequently contained large extravasations of blood; of a dark-red blackish tarry colour, which sometimes extended downwards into the true pelvis.
The urinary bladder was sometimes contracted, sometimes greatly distended.
The mucous membrane sometimes showed punctiform ecchymoses. The urine in some cases contained blood.
The uterus and its appendages showed frequently small haemorrhages in the mucous membrane. The liver was usually enlarged, of a brownish-red or greyish-red colour, and of a firm consistence. In many cases smaller or larger extravasations of blood were found under the capsule. The parenchyma was often cloudy. The boundaries of the lobules were often ill-defined, and the intra-lobular vessels were as a rule filled with blood. In some cases, in which during life there had been icterus, the liver was of a greyish-yellow colour. The gall-bladder was frequently enlarged, and tightly distended with dark-green bile; its walls were sometimes oedematous.
The stomach was often contracted. The mucous membrane was sometimes whitish-grey; more commonly, however, markedly hyperaemic, especially at the summits of the folds, and thickly covered with mucus. Petechiform blood-spots, and haemorrhagic erosions of the size of a lentil, in great numbers, were of frequent occurrence in the mucous membrane. The contents of the stomach consisted often of brownish-black masses.
The whole intestine was as a rule markedly hyperaemic, was often contracted, and usually contained bile-stained masses. The mucous membrane was often thickly coated with mucus; and showed in most cases small haemorrhages and ecchymoses, which were most commonly situated on the summits of the folds.
The solitary follicles were in nearly all cases more or less swollen, especially in the lower part of the small intestine, and often attained the size of a pen or a bean. The Peyer's patches also were almost always enlarged, and raised above the surface of the membrane. The patches were frequently denuded of epithelium, and were often the seat of ulcers with undermined walls but free from sloughs. Haemorrhages in the Peyer's patches were also observed in many cases.
In the mesentery, in many cases, there was extensive extravasation of blood. The mesenteric and the retro-peritoneal glands were in nearly all cases affected in more or less considerable degree. They were enlarged up to the size of a bean or a hazel-nut, and were either whitish in colour, or, more commonly, in consequence of a considerable degree of hyperaemia or haemorrhagic infiltration, they were dark bluish-red. In about 60% of the cases the mesentery was thickly studded with glands of all sizes and degrees of inflammatory change. The mesenteric and retro-peritoneal glands were sometimes surrounded by extravasated blood, and were frequently in a state of inflammatory softening. The blood and lymph vessels between the affected glands and the intestine were in most cases dilated, and of a blue or bluish-red colour. In those cases in which no external buboes had been formed, the changes in the intestine and the stomach, together with those in the mesenteric and retro-peritoneal glands, constituted the most conspicuous morbid appearances.
The pancreas was usually hyperaemic, but showed no other morbid change.
The mucous membrane of the pharynx was generally dark-red. The tonsils were sometimes enlarged and dark-red.
The sub-maxillary glands showed no change beyond slight hyperaemia.
The parotid glands were sometimes swollen and markedly hyperaemic.
In the sub-lingual glands, with the exception of slight hyperaemia, no morbid change was found. In the external lymphatic glands the morbid changes were usually much more extensive than in the internal. The outwardly visible buboes consisted in the first place always of the swollen lymphatic glands themselves; and in addition in many cases of the surrounding connective tissue, oedematous or infiltrated with blood. In the latter case, through the matting together of the glands and the surrounding tissue, there arose diffuse swellings of the size of a hen's egg up to that of the fist. In the buboes, the parenchyma of the glands was sometimes uniformly red, or of the colour of wine-lees, or violet, or brownish-red, and either firm or soft in consistence; sometimes whitish or...