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marbled, and of the consistence of marrow or brain, or firmer, like lard. Frequently, small purulent foci were seen in the glands. The swelling of the glands was due to hyperæmia, exudation, hæmorrhage, and hyperplasia of the cells. The distinction between cortical and medullary substance could not usually be recognized. In the inguinal buboes, the glands superficially placed in front of the femoral vessels were much less affected than those lying deeply in Scarpa's space.
These inguinal and femoral buboes extended usually, but not always, through the crural canal into the pelvis. When this extension occurred the iliac and lumbar glands were similarly affected to the femoral glands, and often formed great, compact masses of swollen lymph-glands, surrounded by extensive extravasations extending on one or both sides of the spine up to the diaphragm. In these glands also small abscesses and more extensive suppurations were sometimes found. Not infrequently, moreover, the iliac glands showed much more swelling and change than the inguinal glands. Most commonly the vascular and lymphatic trunks in the neighbourhood of the affected glands were found much dilated and inflamed. If the cervical glands were the seat of the disease, the inflammation often extended, amid surrounding blood-extravasation, to the mediastinum, and frequently also to the axilla. And conversely, the inflammation often extended from the axilla into the neck.
In addition to the developed buboes, in other parts of the body, especially in the axillary and inguinal regions, the glands were always more or less reddened from congestion, and swollen up to the size of a bean or a hazel-nut. This was found to be the case in the bodies of those also in whom during life no definite buboes had been formed.
The termination of the glandular swelling was as follows. The large, painful glandular swellings accompanied by inflammation of the peri-glandular tissue, underwent suppuration in 90% of the cases. The suppuration originated either in the gland-substance itself, by the formation of small abscesses; or else, after necrosis of the glands, in the surrounding connective tissue. The other glandular swellings underwent resolution by absorption of the inflammatory products, but in these cases indurations and enlargements were usually left behind.
According to the pathological anatomy, bubonic plague is a disease characterised by inflammatory swellings of the external and internal lymphatic glands, and especially of the intestinal glands, by great enlargement of the spleen, by parenchymatous changes in the liver and kidneys, by inflammation of the cerebral membranes, and by the production of hæmorrhages.
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III.—MICROSCOPICAL AND BACTERIOLOGICAL APPEARANCES IN BUBONIC PLAGUE.
THE PLAGUE BACILLUS.
In Hongkong in the year 1894, KITASATO and YERSIN discovered a bacillus in the buboes, the blood, and the organs of those that had died of bubonic plague, and also in the blood of patients suffering from the disease. When various animals (mice, rats, guinea-pigs, rabbits) were inoculated with pure cultures of this organism, they suffered from a disease similar to bubonic plague in man. Since that time this bacillus has therefore been regarded as the cause of the disease. In my own researches, by microscopical examination and by culture experiments, I was able in cases of plague to demonstrate the presence of the same bacillus.
A.—Microscopical and Bacteriological Appearances.
On microscopical examination the bacillus was found in fresh bodies (two to fifteen hours after death), in great numbers in the spleen and the buboes; in small numbers in the affected lymph-glands, in the lungs, heart, liver, and kidneys, in the walls of the stomach and intestine, and in the blood. The bacillus was, moreover, frequently seen in the interior of the corpuscles.
By culture experiments with material derived from fresh bodies the presence of the bacillus could be demonstrated in the affected glands, in the spleen, liver, and kidneys, in the walls of the stomach and intestine, and in the urine and the fæces.
In older bodies, in which decomposition was not too far advanced, the bacillus could also be found on microscopical examination in the affected glands and in the spleen.
In addition to the plague bacillus, staphylococci could in some cases be found in the affected lymphatic glands, in the blood, in the kidneys and the urine, and in the liver and the spleen. In the buboes, cocci were very frequently present, and sometimes also the bacterium coli.
The microscopical examination of the blood of 273 patients suffering from plague showed in 212 cases (77%) an increase in the number of the white corpuscles. Bacteriological examination showed in 221 cases (81%) the presence of plague bacilli in small numbers. Shortly before death, and in severe cases, the examination of the blood for bacilli was most frequently successful. In 20% of the cases examined, staphylococci were found in addition to the plague bacilli, most commonly the staphylococcus pyogenes aureus. In quite exceptional cases, streptococci also were found in the blood.
In the pus from freshly-opened buboes, small numbers of plague bacilli were usually found, in addition to pus-cocci, especially the staphylococcus pyogenes aureus, and sometimes also the bacterium coli. Sometimes, however, the pus was sterile and this was especially the case in suppurating buboes of long duration. In the necrotic glandular masses found in the buboes, the bacillus was usually met with in large numbers.
In the blood from punctured buboes, the presence of the plague bacillus could always be demonstrated by microscopical and bacteriological examination.
In the expectoration, especially when bloody, of 20 patients suffering from bronchitis, the plague bacillus was found on bacteriological examination in 18 cases.
In the saliva, the bacillus was found in 14 out of 18 patients suffering from plague. In the vomit, the presence of the bacillus was demonstrated in 18 out of 20 cases examined.
In the fæces, especially when the stools contained mucus and blood, the plague bacillus was frequently found, but its presence could be demonstrated with certainty by culture experiments only. In 28 of these cases there were no buboes. The examination gave a positive result in 38 out of 15 cases.
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marbled, and of the consistence of narrow or brain, or firmer, like lard. Frequently, small purulent foci were seen in the glands. The swelling of the glands was due to hyperæmia, exudation, hæmor rhage, and hyperplasia of the cells. The distinction between cortical and medullary substance conid not usually be recognized. In the inguinal buboes, the glands superficially placed in front of the femoral vessels were much less affected than those lying deeply in Scarpa's space.
These inguinal and femoral buboes extended usually, but not always, through the crural canal into the pelvis. When this extension occurred the iliac and Inmbar glands were similarly affected to the femoral glands, and often formed great, compact masses of' swollen lymph-glands, surrounded by extensive extravasations extending on one or both sides of the spine up to the diaphragm. In these glands also small abscesses and more extensive suppurations were sometimes found. Not infrequently, moreover, the iliac glands showed much more swelling and change than the inguinal glands. Most commonly the vascular and lymphatic trunks in the neighbourhood of the affected glands were found much dilated and inflained. If the cervical glands were the seat of the disease, the inflammation often extended, amid surrounding blood-extravasation, to the mediastinum, and frequently also to the axilla. And conversely, the
inflammation often extended from the axilla into the neck.
In addition to the developed buboes, in other parts of the body, especially in the axillary and inguinal regions, the glands were always more or less reddened from congestion, and swollen up to the size of a bean or a hazel-nut. This was found to be the case in the bodies of those also in whom during life no definite buboes had been formed.
The termination of the glandular swelling was as follows. The large, painful glandular swellings accompanied by inflammation of the peri-glandular tissue, underwent suppuration in 90% of the cases. The suppuration originated either in the gland-substance itself, by the formation of small abscesses; or else, after necrosis of the glands, in the surrounding connective tissue. The other glandular swellings underwent resolution by absorption of the inflammatory products, but in these cases indura- tions and enlargements were usually left behind.
According to the pathological anatomy, bubonic plague is a disease characterised by inflammatory swellings of the external and internal lymphatic glands, and especially of the intestinal glands, by great enlargement of the spleen, by parenchymatous changes in the liver and kidneys, by inflammation
of the cerebral membranes, and by the production of hæmorrhages.
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III-MICROSCOPICAL AND BACTERIOLOGICAL APPEARANCES
IN BUBONIC PLAGUE.
THE PLAGUE BACILLUS.
187 į
In Hongkong in the year 1894, KITASATO and YERSIN discovered a bacillus in the buboes, the blood, and the organs of those that had died of bubonic plague, and also in the blood of patients suffering from the disease. When various animals (mice, rats, guinea-pigs, rabbits) were inoculated with pure cultures of this organism, they suffered from a disease similar to bubonic plague in man. In my own Since that time this bacillus has therefore been regarded as the cause of the disease. researches, by microscopical examination and by culture experiments, I was able in cases of plague
demonstrate the presence of the same bacillus.
10
A.-Microscopical and Bacteriological Appearances.
On microscopical examination the bacillus was found in fresh bodies (two to fifteen hours after death), in great numbers in the spleen and the buboes; in small numbers in the affected lymph- glands, in the lungs, heart, liver, and kidneys, in the walls of the stomach and intestine, and in the blood. The bacillus was, moreover, frequently seen in the interior of the corpuscles.
By culture experiments with material derived frou fresh bodies the presence of the bacillus could be demonstrated in the affected glands, in the spleen, liver, and kidneys, in the walls of the stomach and intestine, and in the urine and the fæces.
In older bodies, in which decomposition was not too far advanced, the bacillus could also be found on microscopical examination in the affected glands and in the spleen.
In addition to the plague bacillus, staphylococci could in some cases be found in the affected lymphatic glands, in the blood, in the kidneys and the urine, and in the liver and the spleen. In the buboes, cocci were very frequently present, and sometimes also the bacterium coli.
The microscopical examination of the blood of 273 patients suffering from plague showed in 212 cases (77%) an increase in the number of the white corpuscles. Bacteriological examination showed in 221 cases (81%) the presence of plague bacilli in small numbers. Shortly before death, and in severe cases, the examination of the blood for bacilli was most frequently successful. 20% of the cases examined, staphylococci were found in addition to the plague bacilli, most commonly the staphyloccus pyogenes aureus. In quite exceptional cases, streptococci also were found
in the blood.
In
In the pus from freshly-opened buboes, small numbers of plague bacilli were usually found, in addition to pus-cocci, especially the staphylococcus pyogenes aureus, and sometimes also the bacterium coli. Sometimes, however, the pus was sterile and this was especially the case in suppurating buboes of long duration. In the necrotic glandular masses found in the buboes, the bacillus was usually met with in large numbers.
In the blood from punctured buboes, the presence of the plague bacillus could always be demonstrated by microscopical and bacteriological examination.
In the expectoration, especially when bloody, of 20 patients suffering from bronchitis, the plague bacillus was found on bacteriological examination in 18 cases.
In the saliva, the bacillus was found in 14 out of 18 patients suffering from plague. In the vomit, the
of the bacillus was demonstrated in 18 out of 20 cases examined.
presence
In the fæces, especially when the stools contained mucus and blood, the plague bacillus was frequently found, but its presence could be demonstrated with certainty by culture experiments only. In 28 of these cases there were no The examination gave a positive result in 38 out of 15 cases. buboes.
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