200'
As for pneumonic plague, two cases, one male and one female, showed signs of
pneumonia without any buboes ; both died. Both were entered as pneumonic plague r
although no bacteriological examination was made.
One plague case, a male, with inguinal bubo, developed secondary pneumonia
and was cured.
Important Observations.
1. This year (1900) there were fewer plague admissions than at the sanw
period in 1899, and the percentage of mortality was higher. The fewer admissicna-
san be accounted for by the lesser incidence of plague among the Parsis to a certain
extent, and by the greater freedom allowed i.n the present regulations for the treat-
ment of plague patients in their own houses. The greater mortality is due to in-
creased virulence of the disease, and to the fact tliat ordinary fever cases, likely to
get infected with plague in the hospital, were not admitted.
2. Incubation.—In cases where the nature and exact time of infection are
known, such as the infection from cuts, falls, cleansing of a godown or out-house
where dead rats are found, handling of dead rats, &c., 1 have noticed that where
the incubation period is less than 48 hours, the cases invariably prove fatal, and
where the incubation period is long, from 5 to 7 days, the chances of recovery are
very great.
3. Delay is dangerous.*—On eleven different occasions our ambulance, which
was telephoned for to fetch plagne cases, had to return without the patient, the
relations of the patient sending one excuse or the other for giving us unnecessary
trouble. Of these eleven, nine patients were eventually brought to the hospital
mostly iu hack-gharries after an interval of from 12 to 48 hours. Of these nine eight
died and one recovered, whereas had they been brought, in our ambulance at the
time, the probabilities are that one or two more lives would have- been saved.
4. Two or more cases from tlie same house.—When several cases were
admitted from one house, as a rule the first cases recovered" and the subsequent ones-
died. This fact emphatically demonstrates that in the infected bouse disease gets-
more and more virulent every hour, and that tbe real safety, therefore, lies in tl e
immediate evacuation of the plaee.
5. Living directly under open tiled roof.—Of the 140 plague admissions, 35
cases had come from garrets, 31 from ground-floor, and ths remaining 74 from
upper floors ; of those coming from the ground and upper floors, 21 used to sleep
either under lofts or staircases. Thegreaterincider.ee of plague on the ground
floor can be attributed to dampness, darkness, and defic'ency of ventilation in addi-
tion to infection carried by rats. In case of attics, however, the chief source of
infection is the dust and dirt falling from the roofs, \\hichtire infested vith iats,
for, even in fairly well ventilated attics, the nun.ber of plague attacks is propor-
tionately much greater. As the greatest incidence of plague is, in my opinion, in
rooms directly under roof, I believe we will win a great battle against plague by
making the roofs water-tight and air-tight wherever possible. In case of laroe
tenement houses, such, as those in which most of the Parsis live, this can be practi-
cally effected at a little cost.
6. Treatment of buboes.—At first I used to treat buboes with ice application,
Ko doubt the ice relieved the pain, but the great drawbacks noticed were that it
caused sloughing of the subcutaneous structures and that it did not prevent the
buboes from spreading. In place of ice, therefore, various applications were tried,
and after repeated failures of one application or the other, I found a paste of guiacol,
extract of belladonna, and camphor answer the purpose best. The paste is made by