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APPENDIX B.
On the occurrence of involution forms of the Plague Bacillus
in the human body.
In January last Mons. Haffkine shewed me involution forms of the bacillus
which he had found in a rabbit dead of plague, and he suggested that I should
examine human bodies to see if similar forms could be found. Accordingly in
many instances a large number of lymphatic glands and other organs were
examined and involution forms were frequently present. The forms seen were
mostly of the rounded or swollen oval shape, and always stained more faintly
than the young early bacilli. This investigation was made for the following
reason. In cultures of plague, as the culture becomes old, involution forms
begin to appear, and the older the culture, within limits, the more distinct arc
the involution forms. So it was thought possible that a similar condition of
affairs might be found in the human body, and that most involution forms would
be present in that part where the bacilli had been longest situated, that is,
where they had first begun to grow: thus, in a case of plague-septicæmia, for
example, if most involutions were found in some particular gland, one might
infer that the bacilli had first infected and grown in this gland. The enquiry,
however, did not bear out this theory, for it was found that the involution
forms bad a direct reference to the period after death at which the autopsy
was made, and in fact they appeared to be a post-mortem change. Thus, in
autopsies made between one and five hours after death, the plague-bacili always
shewed a distinct well-stained normal form; in those made between five and
ten hours after death early involution forms were seen, rounded in shape and
less distinctly stained ; whereas in the few post-mortems made more than ten
hours after death involution forms were plainly seen of rounded and oval shapes
and still more faintly stained. It may also be noted that in cases of plague-
septicæmia some glands shewed more involution forms than others, but the
variations followed no rule, and no conclusions could be deduced from them.
APPENDIX C.
Case of Plague with a Carbuncle.
R. B., Hindu, aged 30, admitted on 24th December 1896, looking very ill.
There is a large mass looking like a carbuncle situated over the hepatic region
and towards the right axilla ; it is round, four inches in diameter and half an
inch above the skin level. It has a red ulcerated surface with beads of reddish
serum exuding from it at various points, and there is no skin remaining on it.
There is a large mass of glands in the right axilla with effusion around them,
the whole filling out the axilla and having the usual appearance of a plague-
bubo ; glands can also be felt in the left axilla and both groins, but they are
only a little enlarged and are not buboes. Patient states that the ulcerated
mass began fifteen days ago as a small boil or pimple ; some native ointment
was applied to it, and then it increased and reached its present size. Four
days before admission he felt a painful swelling in the right axilla, which has
since increased to its present condition, and during this time he says he has had
high fever.
Cultures were made from the bubo in the right axilla, and a pure growth
of plague was obtained from them.
This patient was very ill and there was no means of ascertaining the truth
of the history he gave. But if it was true that the first symptoms of plague
had shown themselves in the formation of the right axillary bubo four days
before admission, it seemed likely that infection had occurred through the
carbuncle.
I have to express my thanks to Professor Bitter, Director of the Institute
of Hygiene, Cairo, to Mons. Haffkine, C.I.E., and to Mr. Hankin for assistance
in this research ; and also to Dr. A. C. Viegas for showing me cases of plague
immediately after he had discovered the existence of the disease in Bombay in
September 1896.
L. F. CHILDE, Surgeon-Captain, I. M. S.
20th October 1897.