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Detailed History of Last Case injected with M. Yersin's
Paris Serum.
Reg. No. 413, Kasi-bin-satwaji, Hindu, female, age four years, admitted on
27th April 1897, at 2 p.m., to Parel Hospital from a chawl at Sewri.
History.—April 25.—At 12 midnight she had a rigor with headache and hot
skin, but no vomiting, diarrhoea, or delirium, and for the remainder of the night
was restless, thirsty, and feverish. She had been playing about and was in her usual
health up till the hour of attack noted.
April 26.—During the day she was up and playing with other children ; but
seemed stupid, quiet, and slightly hot to the touch ; and the same night she was
restless, sleepless, tossing her head and arms about, and had stupor at times. The
urine was scanty and febrile, and the bowels moved naturally once.
At 5 p.m. she complained of pain below the left ear, and a swelling was noticed
in this situation between 8 and 9 a.m. on the morning of the 27th April, She con-
tinued to be feverish and stupid, and at times wandering in her talk, and was brought
to hospital.
Present State.—A well-nourished young female child, drowsy, eyes half closed,
pupils contracted, can be roused to answer questions when spoken to loudly; is irrita-
ble, and appears to want to be left alone. Tosses her head from side to side. The eyes
are not injected. Tongue covered with a thick white fur increased towards the
posterior part of its dorsum ; edges and tip clean and red. Respirations easy, 40 per
minute. Skin hot, head and neck perspiring ; rest of surface hot and dry. Is very
irritable when touched. Heart and lungs normal, abdomen soft and flaccid, liver
palpable in right hypochondrium, extending two inches below the rib. Margin in the
nipple line, and half way between the xiphoid cartilage and the umbilicus. The bubo
consists of a soft swelling, hard in its deeper parts below and behind the angle of the
left jaw, about one inch in diameter in size. Skin over bubo soft and giving a sodden
feel, equal to soft œdema. Two small shot-like glands in the right groin ; no glands
palpable elsewhere, and those in the right groin are not tender, inflamed, or painful.
No eruptions or wounds noticeable. Patient complains of headache, and pain in the
inflamed cervical gland. Temperature 104, pulse 132, soft and compressible, and
markedly small and dicrotic in character, beats very regularly, but feebly.
At 6 p.m. 40 ccms. of the Pasteur Institute antipest serum, prepared by
M. Roux and supplied by M. Yersin, were injected in the flanks as practised by
M. Yersin for plague cases. Temperature 104.4°F. ; pulse 130 ; respiration 44. In
three hours after, there was no change in the general condition of the patient, and the
local conditions were, if anything, more acute. Temperature 104.8° F.; pulse 136;
respiration 40.
April 28 at 8 a.m.—Temperature 99.4°F. ; pulse 120 ; respiration 6 ; skin cool.
Tongue with less fur, headache less. Slept a little during the night without delirium ;
bowels constipated. Bubo painful and very tender, and surrounding œdema increased,
extending over the angle of the jaw and sternomastoid. Urine of a febrile character
containing a little (½) albumen passed three times. Thirst less, but is very weak,
prostrate and irritable.
At 5 p.m.—Temperature 103.4° F. ; pulse 144 ; respiration 36. Pulse small,
compressible, and very feeble. Patient very drowsy, irritable, tossing restlessly about
in bed, trying to get up at times. Bowels moved thrice and motions bad smelling,
green, and watery especially the two last passed. Tongue cleaner. Bubo shows
much more œdema, and is distinctly larger and very painful and tender. Skin hot
and dry. Thirst very great. Headache has returned. Refuses food, medicine, and
stimulants. Breath fœtid. Urine scanty, high colored, and depositing urates. Eyes
sunken and voice low and weak, and she appears to be greatly prostrated,
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