Evening bulletin. [volume] (Honolulu [Oahu, Hawaii]) 1895-1912, 1899-12-23


rome. and one which Is of special inn
portance to England Although the
outbreak at Oporto is frequently term
ed mild" in type, that is no guarantee
that the disease will disappear any the
SOONER. nor that virulent outbreak
may not supervene, either in Oporto or
elsewhere in Western Europe. The
pertinacity with which plague main
tains its hold on a community has been
exemplified again and again during the
past five years; and the mildness of
its first encroachment is no indication
of its subsequent behavior. Hongkong
has had five virulent epidemics of
plague between the years 1S94-SJ.
Bombay has had several recrudescen-
ces during the last threee years, and
Calcutta affords an example of the ten
acity and chronicity of plague apart
from an epidemic form. In many
towns in InuIa 1t was finally believed
that plague was successfully stamped
out. but these hopes and beliefs have,
in every instance. been shattered.
Plague resembles no other disease in
its epidemiology, and 1t Is only by
close study of its peculiarilies that
correrct estimation of its true charac-
VARIETIES OF TYPE.
ter can be formed. The term "bu-
bonic' has been frequently used to
designate true plague, but buboes are
by no means an essenaal sign of
plague. In many outbreaks but few
cases OF a bubonic nature have been
met with, so few, in fact, that enlarge
ment of the glands proves The eXcep-
ton rather tnan the rule. Again,
succession of outbreaks in the same
city seldom preserves the same type;
pneumonia symptoms prevailing in
one, buboes In another, and yet, again,
toxic or septaemic form in the third
accession of the disease. So numer-
Gus are these divergent forms that the
varieties of plague are grouped by sew
eral writer's as ollows:
The Bubonic form. The Pneumonia
variety. The Intestinal type. The
Nervous symptoms, always a feature
in the disease, may be so pronounced
as to put In .-.e shade all minor evil
dences of the disease, and justify the
group being termed the Cerebral.
The names Toxic and Siderans are
conferred upon q rapidly fatal class
of cases in which the usual clinical
signs are absent, and the symptoms
indicate a severe form of toXaemia
merely.
A Tvnbus form imnres n resem-
blance between plague and malignant
typhus fever.
PESTS Ambulans refers to "a mild
form of the disease.
PESTS minor may precede, run con-
currently with, or flourish after an
epidemic of true plague. In Hongkong,
in Calcutta, in Alexandria, on the Vol
ga, ana in many other places, sporadic
of even epidemic outbreaks of Admits
going on to suppuration, dlsintegra-
ton and death of a gland or group of
glands have been recorded. Whether
these are really affiliated with true
plague is doubtful, but the coincidence
Is worthy of note, especially II It be
proved that PESTS minor 10 a forerun-
ner of plague infection.
An enumeration of the various types
is important, as the disease. at the pre-
sent day has been seen but by few
practitioners in Britain, and its APP
pearance upon our shores may remain
undiagnosed for some time IL but one
type, the bubonic, is taken as the
evidence OF its existence.
The danger OF healthy human be-
ings becoming infected by persons III
OF plague is remote. That the human
being can be inoculated by plague is
however, established.
The channel by which plague Is ac.
quired may be either by the alimentar,
canal, by the respiratory tract, or b,
the skin. We have seen that animal,
given plague tissues, or cultures, to ea
suffer from the disease, and there car
be no doubt that human beings are in
fected by food The faeses of rat OF
mouse getting into human food, or file,
from dead rat of plague alighting OF
food, are sufiicinent to cause Infection
There seems little doubt lat the pneu
monte form OF plague is infectious b,
the breath; and nurse In Hongkonl
died of plague in consequence OF tn,