104
[CHAP. II.
isolated by the method of cultures.) With regard to the bubo itself, in certain cases it
suppurates, and it would seem possible for the bacillus to escape in the pus ; but this was
not found to be the case, for in several instances where cultures were made from the pus
no growth of the plague-bacillus was obtained. It remains to make a remark about the
presence of the bacillus in the blood. In a number of early plague cases which will be
detailed hereafter, cultures were made from the finger-blood, but the bacillus could not
be isolated from them, in fact they all remained sterile ; whereas in fatal cases the bacillus
could always be grown from the blood after death, even when the post-moriom was made
one hour after death, and in one instance it was grown from the. finger-blood twenty-four
hours before death. Hence one may say that at least in fatal cases, which form the large
majority in this disease, the bacillus is present in the blood for a certain time before death,
and is able to leave the body in the various secretions which contain blood.
V.—MODE OF ENTRANCE OF THE PLAGUE-BACILLUS
INTO THE BODY.
Having regard to the fact that the initial bubo in plague is usually situated in the
glands of the extremities, especially the inguinal and axillary chains, it appears probable
that the bacillus may enter the body through a lesion of the skin—preferably of the
extremities - and thence travel upwards to the nearest group of lymphatic glands and thus
form the bubo. In order to test this theory a large number of plague cases were examined
to see if any primary lesion in the skin could be discovered through which the bacillus had
entered ; and as the patients mostly belonged to the lower classes, who commonly go
bare-footed and bare-legged, it was usual to find cracks and abrasions about the feet, and
also about the hands, the latter resulting from occupation. Further, as various parasitic
skin diseases, such as ringworm and itch, are very common among these people, it will be
seen that there are many opportunities for the bacillus to enter the body through the skin.
Bearing in mind the analogy of anthrax and syphilis, the skin was examined to see if
any characteristic lesion was similarly present in plague. No such definite lesion was
found, but in certain cases the bacillus was proved to be present in a particular lesion cm
the skin, and as in each instance the bubo was situated in the glands corresponding to the
lesion, this place was believed to be the point of entrance of the bacillus. There was
nothing characteristic about the lesion. It was usually a small ordinary-looking papule on
a slightly inflamed base, with a little scrum at its apex and partly covered by a scab. In
some eases n hair was found growing through its centre, and it seemed to be merely an
inflamed hair-follicle which had been scratched. These cases will now be given in detail.
B., Hindu man, aged 40, came to hospital on 5th October, 1896. Three days ago lie-
was seized with fever, and shortly afterwards found pain and swelling in the left axilla. On
admission he looked very ill, temperature 103, and there was a large bubo in the left axilla.
On the outer side of the left forearm near the wrist, there was a small papule the size of a
pea, with a hair growing through it ; it was slightly red at the base, contained a little serum
at the apex and was partly covered by a scab. It was not painful, and the patient knew
nothing about it ; there were no inflamed lymphatics leading from it. Cultivatiors were
made from the serum squeezed from the papule, and a typical growth of plague was obtained.
Part of the culture was injected into a rat, and the rat died of plague after GO hours. On
t ho same date, 5th October, cultures were made from the finger-blood, but all remained sterile.
This man died on 8th October.