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man may answer in an irritable manner as if resenting being ques-
tioned. But the typical appearance is the stupid dazed look of one newly
wakened from a deep sleep, and there is evident difficulty in realizing
new surroundings, and understanding what is going on around. Vomit-
ing or diarrhoea or both, may be present or not. Buboes should of
course be carefully looked for in the groins, armpits, sub-maxillary
regions, and in fact in all places where glands are known normally to
exist, as they are sometimes found in most unexpected spots.
The bacteria characteristic of plague are found in the fæces, sputum,
blood and lymphatic glands. They are easily detected in fluid with-
drawn from the glands both by the microscope and by cultivation in
agar tubes. As far as the Bombay epidemic shows, it is often impossi-
ble to detect them in the blood, and if they are detected it is generally
of evil omen for the patient. The fæces and sputum contain so many
bacteria in the normal state that it is a matter of difficulty to separate
the plague bacillus from the more robust forms already present, and
though they may be detected by the microscope, it is impossible to tell
for certain without cultivation, whether the forma seen are really the
specific bacillus or not. For ordinary diagnostic purposes, then, it is
best to rely on matter withdrawn from the affected glands, and the
following is the method recommended by M. Haffkine as the easiest
and best. The apparatus required is, a supply of Pasteur's pipettes,
microscopic slides, carbol-fuchsin stain, a spirit lamp, turpentine and
absolute alcohol. Pasteur's pipettes are prepared as follows, from ordi-
nary glass-tubing. The tubing being heated to redness in the flame of
a Bunsen burner is removed from the flame and immediately drawn
out, so that a pipette with very fine tapering point is formed. The
tapering end is about 6 inches long and in diameter a little stouter than
a hypodermic needle. The point is closed by melting in the flame, and
the other end of the tube being closed with a plug of cotton wool
inserted a quarter of an inch within the orifice ; the whole is sterilised
by being rotated in the flame until the cotton is stained of a uniform
brown colour. The skin over the gland must be carefully disinfected
by washing with soap and warm water, and the application of tur-
pentine and alcohol. Then the pipette having been sterilised by
passing several times through the flame of the spirit lamp, the sealed
point is broken off leaving a sharp edge which easily penetrates the
skin. The skin over the gland is now put on the stretch by the finger
and thumb of the left hand, while the pipette is given a final heat in the
flame, and by means of rotatary motion imparted by the thumb and fore-
finger of the right hand is made to penetrate the skin and tissues till it
is felt to enter the gland. The capsule of the gland offers some resist-
ance to the point of the pipette, and when it is pierced the sudden
cessation of resistance intimates the fact at once. In most cases the
contents of the gland will ascend the capillary tube of the pipette at
once, but if not, the mouth may be applied to the end and suction
employed as the mouth will be effectually protected by the cotton plug.
The pipette is now withdrawn, and agar tubes inoculated in the ordinary
way, after which smear preparations may be made on the slides, which
should be allowed to dry, when they can be stained and examined. The
stain may be left to act for two minutes or so.
To study the appearance of the bacterium, a one twelfth immersion
lens is required. The characteristic appearance is that of a bacterium