269
No.-
20
HONGKONG.
REPORT ON PLAGUE.
Zaid before the Legislative Council by Command of His Excellency the Governor.
HON. COLONIAL SECRETARY,
(Minute by the Acting Colonial Surgeon.)
I forward herewith for the information of His Excellency the Governor a short report by Dr. WILM on plague.
This will be supplemented by a further report after more exten-led investigations have been male with the apparatus which is expected shortly from Europe.
20th May, 1896.
No. Th.
I.-CLINICAL SYMPTOMS AND PATHOLOGY.
J. M. ATKINSON, Acting Colonial Surgeon.
(a) Most of the cases began without prodromal symptoms. Europeans and servants of Europeans generally show a sudden development of the disease in the middle of work, having felt quite well up to the time of attack. The fever begins suddenly and prostration and the other well known symptoms of Plague rapidly set in. In from 1 to 5 or 6 days after the fever begins, the glands begin to swell—at least as far as they are perceptible by palpation. Some cases show prodromal signs, but they are the minority.
(b) Regarding the general symptoms in my experience there has been a marked facies in the disease. Congestion sometimes increased even to sugillation round the eyes and on the forehead and cheek bones ("Black Death"-Schwarze Tod)-apathy to surrounding events-a certain painful tension, caused by oppression, glowing hot injected eyes, soon sinking back into the sockets, the expression of extreme weakness, dry lips in the later stages of the disease covered with sordes, are the roughly described characteristics of the Plague face.
(c) The tongue is swollen, furred, sometimes dried up, brownish or black as the disease progresses, occasionally with racks or fissures and resembles the worst tongue of the third week of typhus or typhoid fever. In light attacks or in those with a very rapid course this dry stage does not develop so quickly.
(d) The other symptoms of the intestinal tract are want of appetite, great thirst, vomiting, constipation and in many cases later on diarrhoea with bloody evacuations. These symptoms may generally be explained by the fever, but in some cases they are apparently signs of alterations in the structure of the enteric mucous membrane. Indeed, in about 20% (30 in 150 cases), I found hæmorrhages underneath the epithelium of the mucous membrane of the stomach and intestine, in most cases as petechiae with circumscribed edges but occasionally diffuse. The lymphatic follicles and Peyer's patches were swollen in most cases, sometimes elevated and occasionally detached leaving ulcers without slough and with floating margins. Simple injection of the mucous membrane could be seen in nearly all the cases, but there were some in which The alterations were so general in the intestine that the whole disease seemed to be a primary infection of the intestinal tract, with subsequent infection of the blood, especially if there were no externally apparent localisations of the swollen glands. This occurred in 33 cases out of 150. Apparent or marked localisations are to be understood as painful swellings of the glands exceeding, say, the size of a bean.
(e) The respiration was dyspœnic if there was high temperature. In 20 cases out of 150 there was bronchitis and hypostatic inflammation. Haemoptysis occurred in 15 cases (10%). Injection of the bronchial tubes and simple cedema occurred in nearly every case. The cases of bronchitis with bloody expectoration appeared to be more accidental localisa- ons of the Plague germ, as in most cases externally apparent buboes were observed. Pre-disposing catarrhis may have given a good soil for the growth of the bacillus. The bacillus never gave rise to destruction of the tissure here. Tuber- cnlar disease was only in one case evident. The mortality in bronchitis cases is the same as in non-bronchitis cases.
(f) Fever was present in every case but varied greatly in amount. There was no regular typical curve of the fever to be made out as is usual in almost all the other infectious diseases. It rises in some cases to 100° F. whilst in others it may only reach 102° F. The height of the temperature is no measure of the severity of the disease as patients with little fever of short duration generally die as well. The duration of the fever generally lasts from a few hours to some weeks. In about 30% of the recovered cases, the fever of the infection lasted for about five or six days, and this may be regarded