295
The Development of Pustules on the Site of Bruises.-The following case is interesting as pointing to a possible means of spread of Plague. The patient, a Chinese female, aged 35, was admitted in a very low condition. She had a left femoral bubo and tenderness over the left inguinal region. She had been under Chinese treatment and was pinched over the chest and arms, the sites being iudi- cated by symmetrical bruises. There were also two patches of necrosis, one over the inferior angle of each scapula-these were about the size of a florin and were superficial.
Whether these were caused in the process of Chinese treatment or whether they were of the nature of bedsores I am unable to say. The interesting point is that Plague bacilli were found in these two patches. On the site of the bruises small papules grew up, which gradually progressed until they became converted into pustules, and in these pustules, Plague bacilli were found in num- bers. Eighteen days after admission the bubo was opened-no Plague bacilli could be found in it. Eventually the patient recovered. The point of interest in this case is that one should note a possible means of spread of Plague. Under native treatment counterirritation is applied in cases of Plague, and pustules may develop which may contain Plague bacilli. These pustules may be ruptured, or they may dry, and crusts with Plague bacilli be shed as happens with dried sputum in Tuberculosis, and thus acutely infectious material be wafted about. And there are in this Colony sufficiently harmonious congenial surroundings for the growth and life of germs so conveyed.
Subcutaneous Hæmorrhages as a means of proprosis.-As is well known hemorrhages into organs and tissues are common in Plague. They occur as well in the Bubonic variety as in the Septic. When haemorrhages take place under the skin of the extremities they become visible as large patches, bluish purple at first then brownish black, and are generally of unfavourable import. In two cases this occurred. The first was a well noubished Indian Police Constable in good phy- sical condition, suffering from Septic Plague. He was admitted on the 3rd day of illness. The temperature kept up between 101° and 18°, fell to 98.8° on the 6th day, and rose again to 105° on the 8th day. At first the pulse was rapid aud strong, then the rate fell with the fall of temperature, and later it became soft and dicrotic and weak. He became delirious, suddenly extensive haemorrhages appear- ed under the skin of the ankles and elbows, and he died shortly after. The second cases was a male, aged 33, suffering from Bubonic Plague. Large patches of hemorrhage appeared on the anterior surface of legs and dorsum of feet, also on forearms and around elbows. In about three hours after, death ensued.
Small-pox supervening on Plague.-The co-existence of two acute infectious discases like Small-pox and Plague is noteworthy, and I give short notes of such # case. The patient, a Chinese male, aged 3%, was admitted suffering from Septic Plague. It was the 4th day of the illness and the usual signs of Septic Plague were present. The blood examination shewed the presence of Plague bacilli. Two days after, a small papular rash appeared over the body, and the temperature went down to 101 from 102-8. On the 8th day of illness small-pox was unmistakeably developed, the rash becoming typically vesicular, and confluent, and affecting the palate and fauces, as well as the palms and soles. He died the next day. He had not been vaccinated. The source of infection could not be traced. In view of the fact that a varioloid eruption has been stated to occur in some cases of Plague, it is interesting to note that small-pox may undoubtedly supervene. An error in diagnosis may occur when such an eruption exists, but it can only simulate a mild attack of small-pox. When however other signs, all confirmatory, exist-as in this case-there can be no doubt. The course of the Plague seemed to be altogether suppressed by the small-pox.
A case of Plague terminating in Bronchitis and Progressive Atrophy.-The following case is interesting as shewing the depth of debility to which an attack of plague is able to reduce its victim, and the case with which other infective agents are able to obtain an effective foothold and breeding ground. The patient, a Chinese female, age 17, was admitted on the 6th day of her illness suffering from Bubonic Plague. She had a right and a left femoral bubo, and Plague bacilli in her blood. She was very weak, was delirious, her tongue was brownish and dry, and there were sordes about her teeth. There were two small pustules about to inch. in diameter on the right rig, and a small ulcer behind the left knee-from there no Plague bacilli could be isolated. Four days after she developed bronchitis. Examination of sputum shewed no tubercle and no Plague bacilli-the temperature remained peristently high-there was slight dulness in the right base, which