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affection only becomes septicemic before death. If recovery takes place, the bacilli never reach the blood. During the agonal period, the blood becomes full of plague bacilli, the organisms are found in the secretions and excretions of the patient. In the faces, urine, the bile, and the terminal lung adema, plague bacilli may be found in enormous numbers. Such is the general trend of opinion in regard to bubonic plague.
By some it is admitted that when using large quantites of blood for examina- tion, the B. pestis may be found, but that such a result does not justify the conclusion that the disease is of septicemic nature. On the evidence such a con- clusion is quite justifiable. As to the methods, however, through which one or two plague bacilli have been demonstrated in the blood of patients suffering from bubonic plague I am unable to speak.
What is certain, however, is, that in the films prepared according to the method of Ross, and showing the presence of plague bacilli, these organisms were always present in considerable numbers. From the total number of these found in a single drop of blood, one is compelled to conclude that they must be present in great force in the general circulation. Again such organisms are present in the blood frequently previons to the development of a bubo.
Another interesting fact in connection with the septicaemic nature of plague, is the presence of plague bacilli in the blood of patients who are convalescing. Such a result has been found on several occasions, and just as I write, a case of this kind has come under my notice, through Dr. KocH, the Medical Officer in charge of the Plague Hospital. The patient has passed through a severe attack of plague. He is at present convalescing, and an examination of a drop of his blood, stained with methylene blue and eosin, shows the presence of numerous typical bipolar and oval shaped plague bacilli,
From these considerations I am inclined to regard plague as a septicamic disease ab initio. The organisms multiply in the blood, they may be found in the blood at the commencement of the illness, and may even persist in the blood for an indefinite time during convalescence.
The presence of plague bacilli in the blood, previous to the development of the bubo, is of great interest in regard to the modes of entry of the organism into the human body. Such has been the results of my observations of the bubonic type of plague. It is my object now to bring forward further evidence in favour of the views just expressed. These views are, so far as I understand, original, and are stated because of the results which have been obtained and verified by inyself over and over again.
When I arrived in the Colony a little over two years ago, I met with plenty of examples of the classical bubo in all its various situations. I was well aware of the results of the various researches into the subject, and judging from the amount of work which had already been done by many eminent bacteriologists, I did not see that much could be added to the prevailing doctrines of the pathology and bacteriology of the disease. I was cognisant of the fact that the blood had frequently been examined in all varieties of plague, and that rigid bacteriological technique had been used. Considerable quantities of the blood-5-10 c.c.-had been used for purposes of cultivation. As has already been mentioned, plague bacilli have been found in the blood of such cases, e.g., in bubonic plague, but the reports are in harmony in declaring that the bacilli found were few in number, in fact so scarce, that one, under the circumstances, is not justified in pronouncing the cases to be of a septicæmic nature.
I think, however, when one finds, in a single thick drop of blood, derived of its hæmoglobin and subsequently stained, numerous oval shaped, bipolar, non- grain staining bacteria, in the earliest stage of this type of the disease, and frequently previous to the development of the actual bubo itself, we can imagine how large a number of these same micro-organisms must be present in the general circulation. In fact, in order that such a number of plague bacilli can be found in the blood, the organisms must multiply. With these facts before one, the conclusion seems justified that Bubonic Plague is in reality Septicaemic Plaque in which the organisin reaches the general circulation to begin with, multiplies there. producing the symptoms of the disease, and that the actual bubonic manifestation is an altogether secondary development. Further there are other points in favour