222
Contagious nature of
the disease.
The relations between the-sick arid healthy undoubtedly exercise a most import-
ant influence on the propagation and extension of the disease. In the absence of
quarantine, perfectly free intercourse existed between the healthy and the sick, and it
has been noticed that persons living in the same house with the sick are peculiarly
liable to suffer, whilst those brought only into occasional contacts are not so likely to
become infected. This observation.has been well illustrated in the various hospitals
where there has been a large staff employed in doctoring, nursing, and other duties of
an occasional character. Out of this number there have been two cases of plague—one
an orderly and the other an ayah. There is no doubt that the disease is " caught "
from the sick by the healthy brought into association with them ; in other words, it is
contagious ; this expresses the wider meaning of the term which includes the process
direct, or intermediate, of conveying its bacillus from the sick to the healthy.
There are several means of conveyance :—
1. By the air, producing the very common and fatal form of primary
plague pneumonia.
2. By the food or drink (acute plague—dysentery.)
3. By the skin.
I am inclined to think that the- latter method is far commoner than is generally
supposed, especially amongst the cases affected with buboes. Out of the following 260
cases of patients dying with buboes, it has been found that there
were-
No buboes
...
...
...
Right inguinal ...
Left
„
...
....
...
Eight axillary ...
...
...
Left
„ ... ... ...
Submaxillary ...
...
...
Cervical
...
...
...
Supratrochlear ...
...
...
Parotid ... ... ... ...
Multiple
...
...
...
.... ...
...
...
...
...
...
...
...
...
...
...
...
...
...
...
... ...
···
...
... 94
... 60
... 58
... 19
... 11
... 7
... 1
... 1
... 1
... 8
From the above it will be seen that by far the largest number of buboes affected
the groin. The explanation of this appears to be, that the large majority of Cutchees
wear no protection to the feet, and it is perfectly easy to understand that, under these
circumstances, ever so slight an abrasion of the superficial epithelium (an unavoidable
occurrence in a barefooted race) would provide a mode of entrance to the bacillus
followed by an inflammatory condition of the nearest glands.
The same principle applies equally to other parts of the body. The next largest
number to the inguinal are the axillary, the right axillary nearly double the left,
because the right hand is not only used more than the left, but is almost exclusively
used in eating.
The submaxillary becomes infected by the entrance of the bacillus through a
carious tooth, the supratrochlear from the hand, and the parotid through Stenson's Duct.
The cases fairly illustrate the frequency of direct inoculation, which in the present
state of our knowledge should come under the old head of contagion.
Of other means of indirect contagion there appears to be some evidence of the
transmission of the disease by the agency of clothes and bedding which have been used
by the sick, but the main point in connection with the liability of the healthy to con-
tract the disease seems to be dependent on the intimacy and regularity of communi-
cation with the sick.