5
be obtained from the blood as well as from lymph from enlarged glands ; and
in pneumonic cases they were obtainable from the sputa and from enlarged
glands when present. Bacilli were probably also present as a rule in the sputa,
vomit, urine and focees of plague patients, but they were hardly ever found in
the blood taken from the finger in cases where a bubo was present from the first.
The slow spread of plague and the immunity observed among hospital ser-
vants, nurses and medical men who were in constant contact with the disease,
handling the sick, and making post-mortem examinations, indicates that the germs
produced in the bodies of the sick are but little infectious to healthy persons
under ordinary circumstances. The conditions under which they become virulent
will only be known when the life history of the microbe outside the body has
been traced. Infection occurred most frequently among those living in the same
rooms with, and in constant attendance on, the sick, and there can be little doubt
but that among the poor and ignorant it was often due to the common custom
which exists of friends receiving the sputa of the sick in their hands,* and using
their hands and clothing to wipe away discharges from the patient's mouth. It
is easy to understand also that want of personal cleanliness among the friends
of those affected, and the neglect of precautions as to the disinfection of clothing
soiled by the discharges and excreta of the sick were fruitful sources of infection.
Plague in its epidemic form, as seen in Bombay, is a malignant infectious
disease characterized, in the majority of cases, by enlarged and painful lymphatic
glands, high fever and great prostration ; and is due to the presence in the
system of the plague bacillus.
In the Bombay epidemic the period of incubation varied in duration from
36 hours, the shortest,† to ten days, the longest‡ recorded, while in the majority
of cases the period of incubation appeared to be, from four to six days.
No definite history of premonitory symptoms could be obtained, the invasion
being, as a rule, sudden and marked by severe rigors or by chills. In infants
and young children convulsions frequently ushered in the attack. In a small pro-
portion of cases, however, no marked onset was noticed, the patients stating that
the disease began with fever, heat of the skin and pains in the limbs. These cases
usually ran a mild course ending in recovery.
The Symptoms in a typically severe case generally commenced with a"well
marked rigor, which was followed by fever, accompanied by vomiting, headache
and intolerance of light, pain in the epigastrium and frequently also in the back
and limbs. Thirst was unusually much complained of. The temperature rapidly
rose to 104° P. or more, reaching its maximum, often 105° F. or 106° F. on the
evening of the second or, more rarely, on the first day ; occasionally a remission
of I o F, or sometimes more, occurred during the day, but with no regularity
as to time. A well marked fall in temperature of 2° F. to 3° F. or more was
frequently noticed on the second or third day, after which the temperature rose
again, but seldom to its former height (vide Charts III, IV, VII, X, XV, XVII,
XVIII, XIX, XX,XXII ) ; a further fall to normal, or subnormal, occurred be-
tween the fifth and seventh days (vide Charts I, II, III, VIII, XXII). In un-
complicated cases a fall to normal sometimes occurred on the second or third day
(vide Charts XX, XXVI), and was often attributed to a particular line of treatment.
* It seems not improbable that plague cultures grow in the ghee always present under the nails
of natives -who eat curry with their hands, and that they often infect themselves from the cultures
when scratching skin eruptions. &c.
† The case of Chinwal Khan reported by Surgeon-Major MacCartie, Health Officer of the Port
of Bombay, on the 11th January 1897.
Chinwal Khan was a fireman on the S.S. Hydaspes which arrived from Shanghai (an unin-
fected port) on Thursday, 7th January, and entered dock the same evening. He did not complain
of illness during the voyage to Bombay, and was on regular duty up to the evening of the 7th.
Probably on that evening and certainly on Friday morning the 8th ho visited the city. On
Saturday morning the 9th he complained of fever and pain in the groin, and on examination was
found to be suffering from plague. The incubation period in this case was at most 11/2 days and
may have been only one day.
Nurse Joyee went 10 attend on Surgeon-Major manser on the 4th January at his house. she
was in good health and had not been near plague cases up to that day. She nursed him from 4th
to the morning of the 6th. She was attacked by plague on the evening of the 7th, and died on the
9th January 1897.
I This period cannot be accepted as finally settled, as the person attacked, a native of Bombay,
may have carried the infection with him and infected himself in Poona, where he was attacked ten
days after arriving from Bombay and before plague had broken out in Poona.
B 1751—2