108
[CHAP. II.
80 this was a case of plague, in which during life all the symptoms pointed to disease
of the lungs, and in which there were no evidences of glandular enlargement, whilst after
death there was clear proof of enormous growth of plague-bacilli in the lungs, and of only
very slight growth in the lymphatic glands.
I have made up to the present twelve post-mortems on such cases, all presenting
appearances similar to the above, and I may add, that all the patients were brought to
hospital by their friends, supposed to be suffering from cough and fever, and, as far as
I know, they were quite unaware of the nature of the disease. I have also to say that
in nearly all the other cases the fluid from the trachea or bronchial tubes has also been
examined ; it shows an immense number of plague-bacilli, and cultures of plague can
always be obtained from it.
Dr. Manser's case.
With regard to the clinical symptoms of these cases, it fell to me to attend on the late
Dr. Manser, and as he died of this form of plague, I will
mention a few facts about his case. He was in bis usual
health on January 2nd, and had a sudden rigor in the morn-
ing and felt fever coming on. During the day a bad headache developed, he felt nausea
and vomited several times, and he had pains and a tired feeling in his limbs ; his tongue
remained clean and moist, and his skin was slightly moist. At 2 P.M., temperature 103 . 4,
pulse 116, respiration 25, and there were, but slight variations during the day. On
January 3rd, had passed a bad night and felt worse, and all the symptoms persisted,
except the celling in the limbs, and he felt very ill. The temperature remained between
103 . 5 and 104 . 5, pulse about 110, and respirations about 23 throughout the day. During
the afternoon he felt some pain at the lower part of the left axilla, just under the anterior
fold, but there was no glandular enlargement or pain in the glands anywhere. On January
4th, had passed a bad night and felt very ill, temperature 104 . 6, pulse 113, respiration 25,
tongue still moist, with a little fur behind, and no sordes about the lips or teeth ; the other
symptoms as before. During the night he began to cough and brought up some watery
sero-mucous fluid, slightly blood-tinged, and the pain remained in the same place, only
more diffused now, being felt over an area of a square inch. At this part some moist
sounds could be heard like those of early pneumonia, and they could also be heard just
below the left clavicle ; the rest of the lungs and other organs appeared to be normal, as
did the lymphatic glands. Patient considered that he had pneumonia, but the symptoms
were not like ordinary pneumonia. For the onset was different, the condition of the tongue
and mouth different, there was no dyspnoea or pneumonic disproportion of pulse and
respiration, and the sputum was not at all like rusty sputum ; for it was loose and free,
coming up with the slightest cough, it was watery, looking more like serum than mucus,
and it was slightly pink, not rusty yellow at all. Also there was the striking fact that the
patient's general condition was far worse than could be explained by the small amount of
lung-disease present. So I examined the sputum under the microscope, and found it full
of bacilli looking like those of plague, and cultures were made from which a pure growth
of the plague-bacillus was obtained. During 4th and 5th, patient became steadily worse,
his temperature remained about 104, and his expectoration became most profuse ; the moist
sounds were heard over a larger area, as well as slightly at the bases ; the respirations
increased to 35, and then to 45, and the pulse to 120 and 185 ; and he ultimately died early
on January 6th.
There is also the case of the nurse who attended him, who unfortunately died of a
similar form of plague. In brief, she became ill on the evening of January 7th, and showed