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It is possible, as an exception to the rule, to contract the disease and exhibit
all the symptoms in a mild form by means of bacilli toxine. Without the introduc-
tion of bacilli, this might be acquired by direct inhalation of the breath of a plague
pneumonia case.
That mild cases of plague may occur from the entrance of enervated microbes
in a spent condition or at a period when they are about to proceed towards dissolu-
tion.
Being essentially a lymphatic disease, in the first instance originating through
an alteration of the lymph in the gland or glands, the continuity of lymphatic
tissue in no way, whether going to or from the glands, becomes diseased.
Infection through inoculation, however feasible and correct, leaves room for
doubt. The large proportion of cases who were absolutely free from any detect-
able source of such infection requires further explanation in reference to the
glandular type.
That there are no premonitory symptoms such as is found in other infectious
fevers is verified from the fact of its setting in with full intensity, but, if incipiently,
the condition of the tongue to an experienced observer offers sufficient confirmation
of the system having become invaded.
That a person saturated with syphilis even to a mild degree is afforded some
protective immunity against a severe attack, and opium also bears the same influence
(vide my separate report sent in on this subject).
N.B.—Professor Yersin visited the hospital on two separate occasions and
declined to use his curative lymph. The many patients present were, in his opinion,
unsuitable to his purpose or otherwise too far advanced in the disease.
Treatment
Has to be adopted under the heading of general and local forms.
General.
On the first outbreak of the disease, the pneumonic form appeared to have been
overlooked and attention directed to the glandular class only. With this view
it was considered necessary to administer antipyretics and to apply antiseptic
hypodermic injections deeply into the gland. The reduction of temperature and
the destruction of some unknown quality within the gland were apparently the chief
objects sought for. This line was followed more on theory than knowledge, from
the fact that we did not coneaive the phenomena set up after the toxine had access
into the blood circulation. The chemical change produced in this fluid and the
physiological and pathological results induced on the whole human organism
through blood practically poisoned and decomposed by material generated in the
course of culture by these bacilli, escaped our observation. There was no litera-
ture available to guide us, and we had, as it were, to rely on our own resources and
discoveries and trust more to luck than a defined purpose.
On going buck to old writings, we find the first intention was to thoroughly
clear the prima via, und this was done with a smart purgative combined with
mercury. Calomel was the drug, but Bulard notes that it was always thrown
up or evacuated by the watery motions which it causes. M. Velpean states, on the
known action of this drug on the lymphatic system or glands, that he tried mer-
curial frictions and blue pill ; the effect was such that it remained doubtful whether
the medicine or the disease was the worse, and Bulard further asserts that no faith
should be placed on this ingredient.