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In December 1898 an ambulance cooly died of plague in his own house. It
is suspected that he must have caught the infection from outside, for none of the
other coolies working with him were attacked, while there was much plague in the
locality where he was living.
Incubation
period.
As regards the incubation period of plague, no proper observations could be-
carried on, owing to conflicting statements made by patients and their relatives, and
from the impossibility of ascertaining where the infection was caught.
Chinaman's
case.
However, in connection with this, the following case, Reg. No. 2412, is very
interesting:—
Kwok Nam, 30 years, male, a Chinese cook on board the S.S. " Bormida,"
was admitted into the Modikhana Hospital on the 21st March 1899, suffering from
undoubted symptoms of plague. The history was that the steamer left Hongkong,
which at that time was free from plague, and on the way touched Penaug, also free
from plague. For about 7 days before reaching Bombay, the patient was suffering
from fever, and on the morning of 21st when the steamer arrived in the harbour,
he became violently delirious. He was in consequence immediately removed to the
Gokuldass Tejpal Hospital where ho was refused admission, and whence he was
sent direct to this hospital. On admission he had a typical phlyctenular ulcer
below the umbilicus and a bubo in each groin. Pure cultures of plague were
obtained by Lt. Listen, I.M.S., from the blood taken from the bubo from the left
groin and also from blood taken from a puncture near the ulcer. Thus there was no
question as regards the diagnosis ; for that was proved not only clinically but also
bacteriologically. Where could he have therefore caught the infection? If he got
it in Hongkong, was it possible for it to take such a long time for incubation?
CLINICAL DESCRIPTION.
Clinical
notes
Onset.
The commencement of the illness in most cases was sudden, accompanied
by a sensation of chilliness often going into rigors. In some cases there were preli-
minary symptoms present, such as malaise, headache, or a feverish state, but
generally these were absent, patients being quite well until the suuden onset of chilli-
ness. The temperature soon rose to 102° and upwards, the initial rise being rapid,
and it continued to be high until about the 4th day when there was noticed a
tendency for the fall of the temperature. This was marked in mild cases in which
there was no subsequent rise in the temperature after this fall. There was no case
of hyperpyrexia noticed, the highest temperature being 106°F.
Characte ristic
Symptoms.
The fever was accompanied by the following characteristic symptoms, which,
in the absence of bacteriological diagnosis, served as guides in arriving at the-
diugnosis of plague :—
1. Characteristic general appearance.
2. Certain nervous symptoms.
3. Want of tone in the pulse.
4. The presence of bubo in the bubonic cases.
General
appearance.
1. Most of the patients had an anxious frightened look, sometimes apathetic,
dull and heavy. They generally preferred lying on one side with legs drawn up,
unless prostration was marked, when the decubitus became dorsal, face flushed, con-
gested and swollen looking, the color of the skin of the eyelids, nostrils and lips dusky,
conjunctiva injected, sometimes bloodshot, eyes watery.
The speech was noticed to be quite characteristic, words being uttered in a
peculiar confused, hesitating, stammering manner, something like the speech of a
drunken man.