11
for the sake of saving the house from disinfection and the people from going to
camp, &c., turn the sick into the street, if they thought there was any chanoe of
effective concealment.
Accompaniments to the above report.
Dr. ChoJcsey's report.
With reference to your inquiry as to the difficulty in diagnosing cases of Plague
in the epidemic of 1898-99 and the present epidemic, I have the honour to state
that it is almost impossible to diagnose a certain proportion of cases of Plague, in as
much as they present no evident symptoms, and are unaccompanied by visible signs,
i.e., buboes, or sputum, There are also, in addition to the above, some cases that
have no buboes, but only a slight and almost imperceptible infiltration, more liable
to be overlooked than otherwise, and which prove fatal within a short time. In all
these there is a reasonable suspicion of Plague, and rapid death alone, with or
without a bacteriological examination, confirms them as Plague cases.
It is evident that cases of such types exist in greater numbers than shown in
Hospital Returns, and are likely to be mistaken for ordinary fever. It is only
where they prove rapidly fatal that suspicion is aroused.
The difficulty in diagnosing such cases is no doubt becoming greater every
year, as the disease tends to change its type, time after time, and even during a
single epidemic it seems to run in cycles of a particular type for certain definite
periods. As an instance of this may be cited the cases admitted into the Arthur
Road Hospital in January J 900. Many of these were cases of septicemic Plague
with and without buboes, with normal or subnormal temperature in the morning
and the evening temperature not exceeding beyond 100 or 101 .and accompanied
by a weak and extremely irregular and intermittent p.ulse. Such cases, if not
closely investigated, are extremely likely to be overlooked, and so also cases of plain
infiltrations unaccompanied by buboes and proving rapidly fatal. The former type
has now totally disappeared, whereas the latter still exists.
Most of the cases sent as " suspicious " to this hospital turn out to be relaps-
ing fever which, without much previous experience, it is not easy to diagnose off-
hand. And about 90 per cent, of relapsing fever admissions into the hospital have
been diagnosed as such from the observation wards, where they had been admitted,
as " suspicious " cases.
As regards Plague, about 10 to 15 per cent, of the total admissions have been
similarly diagnosed from the Observation Wards.
Extract from Dr. Dhargalkar's report.
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In the epidemic of 1899, 225 cases wero sent for observation in the month of
January, out of which 49 cases developed Plague. It was not very difficult to
diagnose a Plague case during that epidemic, as more than 70 per cent, of cases
developed Plague, while out of 426 Plague cases sent to this hospital, during January
3899, ten cases proved to be diseases other than Plague.
In the present epidemic a largo number of cases is sent for observation which
die within 2 or 3 days and in which the diagnosis remains doubtful. On the other
hand a large number of patients is sent to the hospital as Plague cases but which turn
out to be either relapsing fever or smallpox cases. So the difficuliy in liajnosino-
Plngue cases during the present epidemic is increased. During the month of January
1900, 235 cases were sent for observation, of which 30 cases developed symptoms of
Plague, but a large number died in which the diagnosis has not been certain. Out
of cases sent as Plague about 22 cases proved to be diseases other than Plague.