MEDICAL ASPECTS or PLAGUE.]
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symptoms of pneumonia on January 8th. She rapidly became worse and died on the 10th,
but her sputum was not nearly so profuse as in the former case, and symptoms of exhaustion
came on much earlier. She also had no glandular pain or enlargement whatever, and
bacteriologically her sputum was exactly as described above. Other cases were met with, in
which, besides plague-pneumonia, there was also general enlargement of the glands,—
plague-septicaemia ; and clinically it was found that either the pneumonia was primary, and
the glandular enlargement secondary, or that the disease first shewed itself in the glands and
later on in the lungs ; and whilst some of the latter recovered, the former were usually
rapidly fatal. Also the sputum was not always as has been described above, for in some
cases the presence of blood in it was a marked feature, und it was either moderate or abund-
ant in quantity. These pneumonic forms of plague are highly infectious, and probably
take a large share in the spread of the disease ; for in these cases the patient's sputum
is practically a virulent, pure culture of the plague-bacillus, and as there is reason
to believe that many of the cases are not recognised as plague at all, precautions
are not taken by the patients' friends, and the dangerous nature of the disease is
not appreciated. I have no means of knowing how frequent this variety of plague
has been in the present epidemic, but there is some evidence to show that a consider-
able number of cases have occurred. Moreover, it seems likely that a ship's passenger
suffering from this form of plague might escape detection by sanitary officers, and might be
permitted to land at his destination as though he were the subject of simple pneumonia ; and
so a centre of infection for the spread of plague would be established. With regard to the
literature on this subject, I have not been able to find a published description of this variety
of plague ;* but an allusion to it is made in the accounts of the Pali epidemic of 1836, and it
is stated that the Astrakhan outbreak of 1877 was first regarded as croupous pneumonia or as
typhus complicated by pneumonia ; from the reports on the Hongkong epidemic it appears
that plague-pneumonia did not occur there. There is just this to add : the usual definition
of plague in works on medicine is—" A specific fever attended by bubo of the inguinal or
other glands," but it is clear that such a form of words does not include all varieties of the
disease. (This paper was road before a meeting of the Bombay Medical and Physical Society
on April 2nd, 1897.)
[Appendices B and G to Dr. Childe's Report are omitted. They deal with involution
forms of the bacillus in the human body, and with a carbuncular case of plague.— J. K. C.]
SUMMARY OF WORK CARRIED ON BY MR. HANKIN.
Mr. Hankin has carried out a long series of researches on the action of disinfectants on
the microbe of bubonic plague. He finds that it is somewhat resistant to the action of
carbolic acid. Both phenyle, lysol, and izal appear to have a more energetic action.
Phenyle and lysol, however, were found uot to exert a marked bactericidal action on a cow-
dung floor. Naphthaline was found to have no action on the plague-microbe. The plague-
microbe was found to be comparatively resistant to the action of alkalies, and especially
sensitive to the action of acids. Even weak organic acids appear to destroy it readily. It
is, however, usually able to exist for some hours in acid urine. Milk, so soon as it has
acquired an acid reaction, appears to have acquired the power of destroying the microbe.
Inorganic acids are naturally still more active, and Mr. Hankin thinks that sulphuric acid
might be used as a cheap disinfectant against the plague infection. The microbe was
found to be resistant to the action of reducing agents, and sensitive to the action of
oxidising agents, such as permanganate of potash or chloride of lime. A solution of one
part of permanganate of potash in 50,000 parts of water appears to be capable of destroying
* Vide p. 5, where an account by Dr. White is given.—J. K. C.
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