MEDICAL ASPECTS OF PLAGuΕ.]
107
APPENDIX A (to Capt. Childe's Report).
On the Clinical Aspect of Plague-Pneumonia.
When plague appeared in Bombay, and as the disease developed, one was struck by the
following facts:—First, in all published accounts of the disease, although the ordinary phase
of the malady, viz., plague with buboes, is principally described, still mention is always
made of another and more fatal form without buboes ; whereas, here in Bombay it seemed as
if the bubonic form were alone appearing, for, at the beginning, one saw no examples of the
other form. Then one observed that coincidently with the increased, death-rate due to plague,
there was a large and unexplained increase assigned to remittent fever and respiratory diseases.
Week by week, as the plague mortality increased, so did that under these two headings, and
though it was possible that all these were cases of known but concealed plague, still one
could not help suspecting that some of them might be due to plague which was not diagnos-
ed because of the absence of buboes. So I resolved to examine the bodies of all hospital
patients who had died of fever, pneumonia, or any acute illness, to see if there were evidence
that any of them had really died of plague. And at the end of December I met with a case
which had been diagnosed as broncho-pneumonia, but which turned out to be one of plague
affecting the lungs, without causing any marked enlargement of the lymphatic glands—
α case, in fact, of plague-pneumonia ; and its post-mortem was exactly like many others that
I have since made, typical of the disease, and I will give a few notes of it.
B. L., Hindu, male, 25 years old, admitted for fever and cough, December 26th, 1896,
under Dr. S. He said he had been ill for about seven days. He had symptoms in the
chest which led to the diagnosis of broncho-pneumonia being made. No lymphatic glands
were found to be enlarged or painful, and a specimen of blood taken by Dr. S. shewed no
plague-bacilli under the microscope. He coughed up about two ounces of blood-stained
fluid on the night of the 27th, and died at 3 A.M. on December 28th.
Post-mortem on December 28th, seven hours after death.
Lungs.·—Much general engorgement and oedema, with sero-sanguineous frothy fluid
in the bronchi, but no pus ; and the usual appearances of acute bronchitis were absent a
There was one small pneumonic patch, the size of a walnut, in the early second stage,
situated a little below the apex on the front of the right lung, and two similar but smaller
patches at about the same part of the left lung. These patches stood out a little from the
surface and were light grey in colour, airless, friable and sank in water ; and each was
surrounded by a dark ring of engorged lung in the first stage of pneumonia, which merged
into healthy lung ; there was some recent pleurisy over the pneumonic areas. All the other
organs were examined and showed considerable engorgement, but no special lesion was
observed.
Condition of the Lymphatic Glands.—The bronchial were quite small and of normal
appearance; the cervical were slightly enlarged, but palo and not engorged ; the axillary
were pink and slightly enlarged ; the left iliac were somewhat large, red and soft ; the
lumbar were swollen but pale ; and all the other glands looked absolutely normal.
Cultures were made on agar-agar from the pneumonic lung and spleen, and ultimately
a pure growth of the plague-bacillus was obtained from each.
Microscope.—The pneumonic patches in both stages showed an immense number of
plague-bacilli, and the rest of the lung showed a large number ; the left supra-trochlear
and the left femoral glands shewed a fair number, and all the other glands extremely few ;
the spleen and blood also showed a few.