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346 China. Pneumonic plague is invariably fatal in from three to four days.

Pathological anatomy and pathology.—After death from plague the surface of the body very frequently presents numerous ecchymotic spots or patches. The number and extent of these vary apparently, in different epidemics. Sometimes as in the Hong Kong epidemic of 1894 they are few and trifling, having their origin, as mentioned, principally in insect bites. In other epidemics, according to their historians, the cutaneous hæmorrhages have been both extensive and numerous; hence the name " black death " formerly applied to this disease. The characteristic buboes are generally apparent; occasionally there are also furuncles, pustules, and abscesses. Rigor mortis is usually moderate; sometimes post-mortem muscular contractions, like those of cholera, take place. Post-mortem rise of temperature is often observed. Decomposition is said to set in early.

The characteristic appearance in a necropsy of plague is that of engorgement and hæmorrhage, nearly every organ of the body participating more or less. There is also parenchymatous degeneration in most of the organs. The brain, spinal cord, and their meninges are markedly congested, and there may be an increase of subarachnoid and ventricular fluid. There are numerous and pronounced puncta cruenta on the brain sections; occasionally there may be considerable extravasations of blood into the substance of the brain (mesocephalon and medulla oblongata). Ecchymoses are common in all serous surfaces; the contents of the different serous cavities may be sanguineous. Extensive hæmorrhages are occasionally found in the peritoneum, mediastinum, trachea, bowel, pelvis of kidney, ureter, bladder, or in the pleural cavities. The lung frequently shows evidences of bronchitis and hypostatic pneumonia; sometimes hæmorrhagic infarcts and abscesses are found. The right side of the heart and the great veins are usually distended with feebly coagulated or fluid blood. In pneumonic plague the superficial lymphatic glands are not enlarged; the pleural cavities contain blood-