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A description of bubonic swellings, their origin, nature, and an interpretation of their formation, is reserved for a special chapter. On exposing the thoracic ca- vity and throwing back the sternuun with its costal attachments, another point strikes one, namely, the presence of marked capillary congestion around the ribs and costal cartilages, specially on their inner surfaces. Again the post-sternal connective tissue shows a perfect network of injected blood vessels. Occasionally diffuse hemorrhages are found occupying the spaces of this areolar tissue.
The pericardial sac is of a reddish blue colour. The parietal layer is studded with engorged vessels ramifying in all directions. In the majority of cases, apart from the presence of hæmorrhage of varying size, the pericardium is normal. Rarely, however, inflammation of the sac is found. Two such cases have come under my notice. In both acute pericarditis was present. The inflammation was hæmorrhagic in type. Plague bacilli were found in the fluid, along with poeu mococci and streptococci. Vide Cases V and VI. The presence of this condition of hæmorrhagic pericarditis in plague is, I believe, very rare, such an inflammation is more commonly met with in tubercular and malignant disease or in cases where there is extreme cachexia.
The visceral pericardium resembled the parietal layer. Hæmorrhages were more frequent, especially over the posterior surfaces of the heart, along the coronary vessels, over the auricles, and about the entrances of the pulmonary veins. Sometimes large crops of such petechia would be found. The pericardial sac always contained a small quantily of serous fluid, which was almost always blood stained.
The actual state of the heart varies. In some cases the whole organ is flabby, with little evidence of post-mortem muscular contraction. In others the left ventricle is found firmly contracted with a flabby and dilated condition of the right sided cavity. In a few cases in which plague complicated beri-beri, the heart was of enormons size. It was what one might term a Bullock's Heart." Large hearts are well known in beri-beri.
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On opening the heart, it is usually found to contain a large quantity of dark, thick, non-coagulated blood. This blood does not tend to coagulate after its with- drawal from the body. This probably depends upon the admixture of the blood with the poisons elaborated by the specific virus.
Ante-mortem blood clots are frequently found, especially on the right side of the heart.
The endocardium is frequently normal in appearance excepting the presence of small hæmorrlages. These are mostly found in the ventricles, and about the valvular openings. These petechia are found as frequently on the left as on the right side of the heart.
Valvular lesions were sometimes met with. In all probability they had nothing to do with the disease.
The myocardium was always found in a condition of degeneration. It was frequently congested with cloudy areas of degeneration, scattered throughout its substance. In other cases the musculature was brownish red in colour and dry. Panctiform petechia are often found between the muscular fibres. Actual myocarditis has never been found, In general, the venous circulation was found in a condition of engorgement. Small petechiae were frequently found on the inuer walls of the arteries and veins.
In all cases of plague, more or less extensive circulatory disturbances are found about the pharynx, larynx, trachea and esophagus.
The pharynx is often hyperannic and edematous. Likewise the tonsils often show great swelling, and on section, occasional hæmorrhages are found in the lymphoid tissue. In certain cases the changes in the tonsils resemble that found in an ordinary bubo. Extravasation of blood, adema, inflammation, and necroses be found present. Plague bacilli are found in great numbers in such tonsils. These cases lead one to believe that, in certain instances, the virus may gain an entrance to the blood stream through this channel,
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