291
Detailing the results of my examination it will be noticed-
(1) that the bacillus pestis was found in some cases during life, and also after death in all the organs-the heart blood, spleen, liver, lungs;
(2) that in some cases (Bubonic Plague 6, Septic 1) the bacillus pestis was not found immediately before death though it was found on several occasions previously during the illness;
(3) that in other cases (10 of Bubonic Plague and 1 Septic) no Plague bacilli could be found during life but were found after death in the various tissues
and organs;
(4) that in 9 cases of Bubonic Plague and 1 of Septic Plague the bacilli were found at the first examination but not on subsequent examinations;
(5) that in 1 case of Bubonic and 1 of Septic Plague the bacilli could not be found either during life or after death;
(6) that in 9 cases of Bubonic and 3 of Septic Plague which recovered Plague bacilli were found in blood films on their admission;
(7) that in 17 cases of Bubonic and 7 of Septic Plague the bacilli were found ante-mortem : no postmortem examination was made in these cases ;
(8) that in two cases I found the bacilli in the peripheral blood after convalescence had been fully established.
It would seem natural to conclude from these observations that the presence of the bacillus pestis in the blood-the peripheral blood-is not constant, that it is not to be found on every occasion of examination in the course of the disease, nor is it present always immediately before death. It is undoubtedly a fact that the bacilli are always to be found in the bubo during its early stages, but when sup. purative and necrotic changes are set up-when the bubo maturates--they cannot always be found. It would seem that streptococcic infection has dominated the position and that the swarm of leucocytes ingest the Plague bacilli and either destroy thein or render them inert. In smears from the spleen I was able to find the Plauge bacilli in the substance of the phagocytes, and in buboes which matured and suppurated I found the bacilli within the substance of the leucocytes while the cocci of suppuration were free. What value is to be placed, as regards its infectivity, on the presence in the peripheral blood of convalescent cases of the bacillus pestis is doubtful. Whether the bacilli are always present in the blool of convalescents, if not always under what circumstances and in which variety of plague, and finally the length of time they persist after convalescence is established are questions which require elucidation.
THE TREATMENT OF PLAGUE.
Owing to the severe type of the disease treatinent was practically hopeless in the great majority of the cases, and in addition a large number were brought in in extremis. Different methods of treatment were adopted and I summarise the results.
A. In the first and earliest method, the administration of carbolic acid in large doses, which apparently gave such satisfactory methods in the previous year, was again tried. The cases were put on twelve grains of the pure acid, made up in a palatable mixture every two hours, and this was continued during the whole course of the illness. Carbolurea never developed. Digitalis and strychnine by the mouth and hypodermically were also administered. With such large doses of carbolic acid there is often a feeling of depression, a buzzing in the ears and a feel- ing of languor and apathy-as if you were floating in the air when you closed your eye", as one patient expressed it. When the patient is able to appreciate it, the emetations are objectionable. The results by this method were as follows:--
Males 17 Females 4 | Males
+
Bubonic Plague :--Cases treated, {
Recovered,
Died,
2
Female 1 Males 15 Females 3
Septic Plague: Cases treated,
Recovered,
Died,
Males
9
Female 1
Males
2
Female 0
Males 7
Female
1