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consideration of the beneficial influence which a continuous flashing of the drains (in
Mandvi, where the disease first occurred,) by a moderately strong solution of per-
chloride of mercury appeared to exert, and which tended to minimise the disease. This
operation lasted for four months, consuming about 70,000 gallons of the solution,
after which the district became the healthiest in Bombay, and any recurrence there
resulted through the inhabitants gravitating from surrounding districts while they
were in a state of incubation or with the disease upon them. Another source
of infection was duo to the disease being " air-borne " to a certain degree, I am
not aware if any Bacteriologist has been able to detect plague germs in the air,
but it is reasonable to argue the possibility of infection by this method. These micro-
organisms, whether from dead or decomposed rats, or soil, become released, ascend
with the wanner atmosphere from below, and, reaching an upper current, travel
with it and are ultimately deposited in a building or a locality. Night-time would
foster their movements, or sunless days. Their range of travel is limited, especially
if exposed to the sun's rays. This accounts, as it were, for the slow manner in
which the whole city became eventually implicated by instalments. Except by
pneumonic plague, I do not think infection is spread by human intercourse,
and in evidence of this statement, those most closely associated with the
disease, as the working staff, from the medical officers down to the coolies,
considering their numbers, enjoyed comparative immunity from infection. Of
about 400 people—men, women, and children,—who either visited their sick friends
or remained constantly by their bedsides, together with the cases under observation,
in not a single instance did any of these persons contract the plague. But one of
the ward orderlies doing duty in the hospital became affected through direct
contagion in consequence of drinking the remnants of stimulants left in feeding
cups by patients who did not consume the whole contents, and most probably after
some cup had been in contact with the mouth of a plague pneumonic
case. His was a severe type. Being relieved from duty at 7 a.m. apparently
in his usual good health, he came to me three hours later with a rigor on,
congested conjunctive, the early signs of a typical tongue, an expression of fear,
frontal headache, with general malaise. His temperature rapidly rose to 105.4,
and there were no indications of any gland being affected. The same evening
some blood was drawn from one of his fingers, and it demonstrated the presence
of bacilli. During the night he complained of acute pain in the right axilla,
and a distinct glandular enlargement could be felt next morning. There was
no lung complication, so that the symptomatic invasion preceded the bubo. During
the early hours of the second morning he sat up and ate a plateful of food brought
in surreptitiously by his wife, and shortly afterwards expired suddenly.* The fact of
bacilli being detected almost immediately in the blood prognosticated an unfavour-
able termination. Here we have a case absolutely free from premonitory symptoms
in a disease so appalling in its nature and so frequently fatal in its consequences,
which seems to correspond with Bulard's description (Dublin Journal of Medical
Science, Vol. XIII), wherein he declares that " plague has no premonitory symptoms."
This, however, is not true in all instances. It is so far correct, that often there
appears to be no warning symptom such as is found in exanthematous fevers generally.
I would lay stress on the infectious disposition of pneumonic plague and its deceptive
character to the inexperienced, since, in the absence of any external glandular swell-
ing, such a case might be mistaken for ordinary pneumonia or broncho-pneumonia,
whereas every particle of sputa escaping is really a nursery of bacilli in itself. In
this form patients would probably be permitted to travel and convey the infection to
any distance. During the early months of the outbreak we were really ignorant
of this pulmonary complication and confined our attention to the presence of a bubo
in some locality or other. At the same time, if I remember correctly, the deaths
from respiratory diseases had considerably advanced, and, in consequence of this
* See page 140.