46
group of lymphatic glands and thus form the bubo. In order to test this theory-
si, large number of plague cases were examined to see if any primary lesion in
the skin could be discovered through which the bacillus had entered ; and as the
patients mostly belonged to the lower classes, who commonly go bare-footed
and bare-legged, it was usual to find cracks and abrasions about the feet, and
also about the bands, the latter resulting from occupation. Further, as various
parasitic skin diseases, such as ringworm and itch, are Tory common among
these people, it will be seen that there are many opportunities for the bacillus
to enter the body through the skin.
Bearing in mind the analogy of anthrax and syphilis, the skin was examined
to see if any characteristic lesion was similarly present in plague. No such
definite lesion was found, but in certain cases the bacillus was proved to be
present in a particular lesion on the skin and as in each instance the bubo was
situated in the- glands corresponding to the lesion, this place was believed to be
the point of entrance of the bacillus. There was nothing characteristic about the
lesion. It was usually a small ordinary-looting papule on a slightly inflamed
base, with a little serum at its apex and partly covered by a scab. In some
cases a hair was found growing through its centre, and it seemed to be merely an
inflamed hair-follicle which had been scratched. Those cases will now be given
in detail.
B., IIinclu man, aged 40, came to hospital on 5th October 1890. Three
days ago he was seized with fever and shortly afterwards found pain and
swelling in the left axilla. On admission ho looked very ill, temperature 103,
and there was a large bubo in the left axilla. On the outer side of the left fore-
arm near the wrist there was a small papule the size of a pea, with a hair
growing through it ; it was slightly red at the base, contained a little serum at
the apex and was partly covered by a scab. It was not painful, and the patient
knew nothing about it ; there were no inflamed lymphatics loading from it.
Cultivations were made from the serum squeezed from the papule, and a typical
growth of plague was obtained. Part of the culture was injected into a rat, and
the rat died of plague after CO hours. On the same date, 5th October, cultures
were made from the finger blood, but all remained sterile. This man died on
8th October.
N.S. , Hindu man, aged 28, came to hospital December 1st, 1896. There
was a large bubo in the vertical set of the right-inguinal glands. He said he
had been ill three days. There were many old cracks and fissures about the
feet and toes, the skin being thick and horny, and some scratch marks on both
legs. On the outer surface of the right calf there was a slightly raised code-
matons portion of skin about one inch long, and on it there was a small bleb,
the size of a large pin's head. From the bleb some thin serum was squeezed out.
Cultures were made from the fluid in the bleb and from the finger blood. A pure
growth of the plague-bacillus was ultimately obtained from the bleb, whereas
the cultures of the blood remained sterile. In this case too, the patient could
give no history of the ædematous patch on the leg, and there was no pain in it.
N., Hindu man, aged 30 years, was admitted, on March 3rd, 1897, with a
bubo at the back part of the right axilla. He had been ill two days. On the
back, near the angle of the right scapula, there was a papule, the size of a pea,
on a slightly-reddened base and partly scabbed over ; it looked like a pimple
which had been scratched. Cultures were made from the serum squeezed from
this papule and from the finger-blood ; a pure growth of the plague-bacillus
was ultimately obtained from the papule, but the cultures of the finger-blood
remained sterile.
P., Hindu boy, aged 16, admitted on October 26th, 1896. On either side
several of the oblique inguinal glands were enlarged to the size of walnuts, and
painful. There was a small unopened papule on the glands penis exactly in the
dorsal middle line ; its apes contained a little pus and serum. It did not look
at all like a chancre, and the boy said he knew nothing about it. Cultures were
made from the papule and from the finger-blood. From the former a pure
growth of plague was ultimately obtained. This was injected into a rat and
the rat died of plague. Cultures of the finger-blood remained sterile. This
patient recovered.