51
bourhood were brought to notice by the voluntary declarations of the
friends, and this circumstance is the more notable when the degree of
intelligence and lethargic mental aptitude of the informants are considered.
In 29 instances more than one case occurred in the same family. How
the poison is transmitted is an indeterminable point, from the few oppor-
tunities of witnessing its actual spread in hospital. The disease is certainly
most infectious in the acute stage. Once the temperature becomes normal,
the risk of infection is over. No instance of the spread of the disease from
convalescents to patients near them under observation or suffering from
other diseases was met with. The body of a patient dead of plague does
not seem to be capable of communicating the disease, except by inocula-
tion, of which one example was seen.
One attack does not confer immunity from another, as one patient
had a second and fatal attack, and one had a relapse. The second attack
was in a woman aged 40 ; convalescent 18 days ; attacked 27 days after the
initial symptoms of the primary attack ; and died five days afterwards. The
primary attack lasted nine days, and the fatal one five days, and in the latter
she developed a fresh bubo in a different site from the original one had
fever, delirium, stupor, coma, and unconsciousness. The general characters
of an acute attack were present in the tongue, pulse, respiration, skin, eyes
intestinal canal, typhoid state, and mental condition. Her temperature
had been normal 18 days when the fatal attack came on. The incubation
period could be fixed at two days in one case, five in another, seven in
another, and ten in another. In the inoculated example, due to a wound*
incurred in the course of making a post-mortem examination (not a Parel
Hospital case), the incubation period was within three days.
That the disease is not infectious in hospitals is a well-established fact
from experience in the Parel Hospital. In upwards of 240 instances the
friends of the patients attended their sick, and in 20 instances scarcely
even left the bedside, and in not a single instance did the disease spread
to the friends. Out of more than 140 attendants on the sick belongingo
to the hospital staff from time to time, only one sweeper was attacked, and
he had been constantly helping in the pust-mortem room and had a very
mild attack with small axillary bubo. Temperature 100° F. at highest.
He resumed his duties on the fifth day afterwards. In three cases amongst
hospital orderlies other and special sources of contagion existed, very
likely to lead to direct inoculation, and are therefore not considered
instances of spread of the disease from mere attendance on the sick. One
nurse belonging to another hospital, whose case is given in detail, was
admitted.
The conclusion drawn is that one of the safest places during an
epidemic is the ward of a sanitary plague hospital, something more than
mere exposure to contagion being necessary to develope the disease—most
probably overcrowding, destitution, deficient cubic space, ventilation, and
sun-light, and a filthy and general insanitary condition of person, clothing",
habitation, and its surroundings.