16
Comatose or semicomatose state of patient. Voice weak, speech, incoherent.
2. The most prominent of these symptoms is the affection of superficial glands ; cases
when this symptom is absent, if there are any, appear quite exceptionally.
3. In a case of plague a microscopic preparation, made with the contents of the- affectec
gland, will show numerous diplobacteria of characteristic shape and size, described for the firs
time by Kitasato in Hongkong.
4. To obtain the microbes with, certainty a patient is to be selected at the height of tin
symptoms, with glands largely increased, and before any injections had been made into th<
glands. At the commencement of the swelling, or in a convalescent patient, a drop withdraw]
from the gland may fail to show the microbes.
5. For making a preparation, an ordinary or a grooved needle, a spirit lamp, a microscopic
slide and 5 per cent, carbolic lotion is to be prepared. Then proceed as follows :
Wash -the skin just over the swollen gland with carbolic lotion. Allow the lotion t<
dry in situ ; pass the needle in the flame of a spirit lamp and leave it to cool down. Stead;
the gland with the fingers of left hand, so as to make it quite prominent, with the ski
tightly drawn over it, and prick the gland through the skin. Press out a drop of th
whitish contents of the gland, withdraw the .needle and burn the part of it which has bee)
introduced under the skin of the patient till it is red hot. Apply the slide to the drop o
lymph pressed out of the gland, and spread it as uniformly as possible over about a half o
the surface of the slide, avoiding any contact between the infective material and the finger
or any other object.
6. Keep the slide in the hand till it is dry, and while holding it in the hand by its fre
end, pass it rapidly in the flame five or six times, with the preparation upwards, till the lowe
surface of the slide felt by a finger is too hot to be left in contact with the finger without pair
Excessive heating or charring will make the preparation unrecognisable.
Disinfect the skin over the gland and apply a suitable dressing if necessary.
7. In a certain number of eases, pricking the gland through the skin fails to bring to th
surface the characteristic material.
A more certain proceeding is to incise, with aseptic precautions, the skin over the g-Iani
and the gland itself, and to take directly from the gland a drop of lymph on the point of
scalpel, spreading it over a slide as directed above.
* Messrs. Kemp & Co., Bombay,
have been instructed how to pre-
pare such pipettes, and have pro-
mised to sell boxes containing a
dozen and half dozen of pipettes
at the cost price of a few annas a
box·
8. Another way consists in sucking up a drop from the gland by means of a sterile
Pasteur pipette, protected by a cotton plug.* For this cauterise
a small spot of the skin just over the gland. Break the fine end
of the pipette and pass the thin part of it rapidly through the
flame several times. Allow it to cool down and insert the pipette
into the cauterised part of skin, steadying the gland with the
fingers of left hand. By a boring motion introduce the tip of the
pipette into the gland. The moment when this is reached will be
felt by the tissues offering less resistance to the penetration of the pipette.
Apply the mouth to the open end of pipette, and while constantly moving the pipette to and
fro, suck up a small quantity of fluid. The best is the thick whitish contents of the gland,
blood to be avoided by changing slightly the direction of the pipette or putting it deeper or
more superficially. Withdraw the pipette and blow out a drop of it on the slide, spreading as
above.
The pipette is to be burnt immediately after this, and all objects used disinfected.
9. The use of a syringe is not advisable.
10. The slide is stained by any of the aniline dyes ana examined with an oil immersion
lens, or sent for staining and examination to the Bubonic Plague ResearcJi Committee, Petit
Laboratory, Bombay.
11. Any operation should be avoided with glands situated on the abdomen above Poupart's
ligament.
10. The Sanitary Commissioner reported on October 24«th that he had
issued the necessary advice to the authorities at Ahmedabad, Dhulia and Surat.
The outlying municipalities were, he reported, fully alive to the importance of
checking the disease at its outset.
SECTION 7.
General remarks.
The position at the beginning of December when Government arrived in
Bombay from Mahabaleshwar was briefly that extensive measures bad been taken
for the protection of Aden, Sind and the Mofussil districts of the Presidency
from infection, and in Bombay City the Municipal Commissioner had been
provided with powers of the most drastic kind for dealing with the epidemic.
He bad found it inexpedient, however, for reasons which appeared very forcible
at the time, to make full use of those powers as regards the segregation of the
sick: but bad adopted extensive measures for improving the sanitary condition of
the city and for disinfecting infected localities, and those measures appeared to
liave had the effect of keeping the disease in check in the city.