Sessional_Paper_1904 — Page 656

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blown up, putrefactively discoloured, and unfit for dissection.

This being so, it is now my practice during plague epidemics to have all bodies, which are in the Mortuary at 5 p.m., examined before finishing the day's work.

The skin is normal in some cases. Eruptions may be present or absent. On close inspection a few small petechia are usually found. These are most fre- quently met with about the groin and auus, the axilla, the mucous membranes of the mouth, pharynx, nose, the conjunctiva. Plague bacilli have been isolated from such petechiæ, showing their origin to be due to a local growth of the causal agent.

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On the other hand. one frequently comes across spots of quite a different origin. These are usually bright red in colour. They vary in size from a pin's head to a pea. Considerable numbers of these may be present. The whole body may be covered with them. Usually, however, the exposed parts of the skin show them in greatest profusion. The face, neck, anus, hands, legs and feet are "spotted. These spots would appear to have nothing to do with the disease directly.

Like most observers, I am of opinion, that they are due to the bites of insects, e.g., flies. In plague, a general degeneration of the tissues takes place. and the virus actively produces extreme degeneration of the endothelial lining of the blood vessels. The capillary walls therefore are in a degenerated condition, accounting for the occurrence of haemorrhages. With such a condition as this present, the bites of insects, slight blows, punctures made by needles, etc., are much more liable to leave their mark by the occurrence of slight or more or less extensive hæmorrhage into the skin and adjacent connective tissue,

In addition to those already mentioned one frequently comes across cases presenting definite skin lesions. These are of a varying nature, papules, vesicles and pustules are met with together in the same case. These pustules may be large in size and resemble boils or carbuncles. These eruptions are found in all the so-called different types of plague. The vesicular and pustular forms of skin lesion are most frequently present.

In one case which was examined post-mortem, an extensive vesicular erup- tion was scattered over the body. A few papules were also present. Some of the vesicles had already developed into pustules. There was no eruption on the palms of the hand or soles of the feet. The eruption was most extensively found on the extensor aspects of the extremities. On superficial examination, the case was thought to be small-pox. A bubo was present in the right groin, containing numerous plague bacilli. Numerous plague bacilli were found in many of the vesicles. For details of this case, vide Case No. I.

In other two cases, the point of inoculation was found, and extending from this, there was slight lymphangitis. Along the course of the latter, secondary vesicles had developed. A bubo was found in the axilla. Vide Cases Nos, IT and III.

True carbuncles aud boils have not been found. They are simply exaggera- ted pustules. I am in agreement with Lowsox who denies the existence of these lesions in plague. They may occur during convalescence as a result of the debili- tated condition of the patient. If they do, they have no connection with plague. but are set up by infection with ordinary pyogenic bacteria.

On cutting open a plague corpse, the first thing which strikes the eye, is the congestion of the subcutaneous tissues. If the body he still warm, blood will be found to well out from the numerous arterioles and capillaries. The tissues them- selves have a bluish appearance, and on closer examination, a perfect net work of engorged capillaries can be seen. Such an appearance is general over the whole body. Extravasations of blood, small and large, are also found in the subentaneous connective tissue. In one case a very diffuse hæmorrhagic extravasation was found extending over the lower half of the anterior abdominal wall, Vide Case No. IT. On dissecting the muscles, one finds evidence of marked degeneration in these tissues. The colour of the muscles is changed to a greyish yellow, they have a dull lustre. Teased muscle preparations show the presence of granular degenera- tion. In other cases, there is marked fatty degeneration as evidenced by the reactions obtained with oxalic acid and Sudan III.