Sessional_Paper_1904 — Page 668

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There was no apparent connection between Nos. 1 and 2. No. 4 had no connec- tion with No. 2. The mesentery contained a large quantity of extravasated blood, in which the lymphatic glands were embedded. The glands were congested with hæmorrhagic extravasations. There was also considerable oedema,

ædema. Every organ and tissue in the body was teeming with plague bacilli.

Case No. IV.--A Chinese female, æt. 18. The following buboes, pigeon egg in size, were found :—

(1.) In the right axilla,

(2.) In the left axilla.

(3.) Around the left external iliac glands.

The hæmorrhage around the iliac glands extended over the ileo psoas muscle, ran along the common iliac vessel to the aorta, and was continued upwards to the point of entrance of the inferior vena cava into the thorax.

Plague bacilli were found all over the body. The woman was 7 months pregnant. No plague bacilli were found in the fœtus.

Case No. V-A Chinese female, wet. 25, prostitute. Buboes were found in the following regions:-

(1.) In the right axilla.

(2.) In the right and left inguinal regions.

The hæmorrhagic extravasation in the inguinal regions extended downwards to the vulva. The extravasation was found in the labia as well as around the anterior portion of the vagina. The epithelial lining of the vagina was hyperemic and showed the presence of a few petechia. The portio vaginalis was studded with minute points of hæmorrhagic extravasation. The arbor vitæ of the cervix was in a similar condition. The cervix uteri and corpus uteri were dematous, with mural hæmorrhages. Hæmorrhages were also found in the ovaries and the broad ligament was the seat of numerous petechia. There was little tendency on the part of the extravasation to travel along the iliacs towards the kidneys and diaphragm. The greater part of the hyperemia and hemorrhage appeared to be confined to the true pelvis. Plague bacilli were found in all organs of the body.

Case No. VI-A Chinese male, wet. 40. The following buboes were found :-

æt. (1.) In both axillary spaces.

(2.) In the mesentery.

The mesenteric lymphatic glands, particularly those corresponding to the ileum were embedded in extravasated blood. The glands were enlarged, hyperæmic, œedematous, and cortical hæmorrhage was well marked. In one or two commenc- ing necrosis was found. This area of bloody tissue was crowded with plague bacilli.

The ileum part of the small intestine was hyperamic. No hyperemic or pathological change was found beyond the coccn. Hæmorrhages of ranging size had taken place into the submucous membrane of this part of the small intestine. The solitary follicles were enlaged to beyond a pin head in size. Many of these were surrounded by an area of congestion. Peyer's patches were ædematous and were marked only by certain degree of surrounding hyperæmia. All other parts of the large and small intestine were normal to the naked eye.

Case No. VII-A Portuguese male, at. 28. Buboes were found in the follow- ing situations:-

(1.) In the left iliacal regions.

(2.) In the right iliacal regions.

(3.) In the left cervical region.

The hæmorrhagic

Plague bacilli were found in the heart blood and buboes. extravasation extending from either iliac bubo met over the lumbar vertebræv. and extended upwards involving the lumbar regions and both kidneys, coming to an end just above the pancreas.

These cases of multiple bubonic formation are of great interest when we look upon plague as being ab initio a disease of a septicemic nature. Given the septic nature of plague, these buboes must be regarded as secondary to blood infection.