47
As confirmatory of the above observations, I may quote as follows from
"A report on the Epidemic of Bubonic Plague at Hong-Kong in the year 1896 "
by Staff Surgeon Wilm of the Imperial German Navy :—" As regards infection
through the skin, two incontestible cases wore observed in the epidemic of 1894.
Two Japanese physicians were infected, while making post-mortem examinations,
and were attacked a few days later by plague. They had axillary buboes
and lymphangitis of the arm, which spread upwards from the small inflamed
wounds of the fingers.
The above are the four cases in which the plague-bacillus was found in a
certain definite situation on the skin, and this place was believed to be the seat
of inoculation of the disease ; moreover, in each instance the corresponding
proximal glands formed the bubo, and there was nothing characteristic about the
skin lesion. It looked like an ordinary pimple which had been rubbed or
scratched, and no local reaction had occurred in it, due to the presence of the
bacillus ; also it was not painful and the patient was unaware of its existence.
It may be stated here that in a large number of other patients small papules or
abrasions were similarly examined, but the plague-bacillus was not proved to be
present. Thus, in one instance a man had acne extensively on the face and a bubo
in the left cervical region ; in another, three small scabbed wounds on the right
foot with a bubo in the vertical right inguinal glands ; in a third, a number of
papules on the left arm with a left axillary bubo, and other cases could be quoted.
Some of the papules were examined in these cases, but with a negative
result. A point remains to be noticed ; it may bo objected that if the bacillus
were already in the blood, it could pass with the serum into a papule wherever
situated, and its presence there would bo the result, and not the cause, of the
disease. But against this view there are the facts, 1st, that in the above four
cases, which were all early, the bacillus could not be isolated from the blood
on the samo day that it was found in the papule ; and 2nd, that in a number of
other early cases pimplos situated in various parts of the body were examined,
not only on the limb corresponding to the bubo, but the bacillus was not found
in them. Also in three early cases of inguinal bubo, a small blister was raised
upon the chest, but the plague-bacillus could not be isolated from the contain-
ed serum.
The conclusion diawn is, that the bacillus of plague can enter the body
through a trilling lesion in the skin, that it produces no local reaction at the seat
of inoculation, and that the bubo is formed at the nearest proximal glands.
With regard to infection by food, no evidence was found post-mortem that
the bacillus had entered through the stomach or intestines ; but cases of cervical
bubo might have resulted from infection through abrasions on the lips, tongue
or tonsils.
As for the cases of primary plague-pneumonia, no evidence of the path of
infection was found, but the bacillus was thought to have entered by the respira-
tory tract, as its growth had mainly occurred in the lungs.
APPENDIX A.
On the clinical aspect of Plague-Pneumonía.'
When plague appeared in Bombay, and as the disease developed, one was
struck by the following facts :—First, in all published accounts of the disease,
although the ordinary phase of the malady, viz. plague with buboes, is princi-
pally described, still mention is always made of another and more fatal form
without buboes ; whereas here in Bombay it seemed as if the bubonic form were
alone appearing, for at the beginning one saw no examples of the other form.
Then one observed that coincidently with the increased death-rate due to plague,
there was a largo and unexplained increase assigned to remittent fever and
respiratory diseases. Week by week as the plague mortality increased, so did
that under these two headings, and though it was possible that all these were
cases of known but concealed plague, still one could not help suspecting that
some of them might be due to plague which was not diagnosed because of the
absence of buboes. So I resolved to examine the bodies of all hospital patients