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In this Colony the men who are employed in these ways are well cared for. Good boots or shoes and socks are provided them free of cost, as well as the uni- form jacket and trousers. The men are prevented from taking off their foot wear while at work. The bottom of the legs of their trousers are worn tucked in below the socks so that a very great protection is afforded against skin infection through the lower extremities.
The clothing of these men is disinfected by steam at the close of each day's work and further the men are compelled to take their bath every evening.
The general absence of lymphangitis in the afferent vessels of the glands involved in a bubo is instanced as evidence against the skin-infection theory. I do not think that it has been yet satisfactorily shewn that lymphangitis is to be expected always when a minute innoculation occurs through the skin, at any rate as an initial symptom.
The Bacillus Pestis is not classed as a pyogenic organism; the localized irritation resulting in lymphangitis may well be caused by the introduction of pyogenic organisms with or after the introduction of the plague bacillus.
The fact that in experimentally innoculated animals lymphangitis has been found affecting the vessels leading from the point of innoculation, on the making of a post mortem examination, is not, I think, sufficient evidence that it ought always to be expected if the bacillus effects an entrance through the skin.
As I said before, innoculations and scarifications are enormous lesions when compared with those through which it has been suggested that the virus finds its way.
In the report of the Indian Plague Commission the President in his descrip- tion of Clinical features of Plague says: "In most cases the lymphatic vessels 'shewed no pathological change and in only a few were they observed to be con- gested and swollen, and that only close to the bubo."
CC
This seems to point to the conclusion that the lymphangitis when it does occur may be frequently a backward process from the acutely inflamed glaudular
tissue.
The opinion of the Government Bacteriologist * is that, if the skin were the place of entry of the bacillus, buboes ought to be as common in the axilla as in the groin. This is directly opposed to the opinion of the Indian Plague Commis- sioners based on their discovery that buboes and areas of skin drained by the lymphatics passing to them have such a mutual relation.
It seems only just to suggest that the glands which are nearer (if not nearest) to the point of infection should shew the earliest signs of pathological change.
The often observed fact that the lymphatic glands throughout the body shew on post mortem examination signs of congestion and are hemorrhagic has been urged in favour of the theory that plague is almost always a septicemia from the earliest stages, and further that therefore skin infection could not be the usual mode of entry of the bacillus.
It is not however by any means impossible for a septicemic condition to be established directly as a sequence of skin infection, nor does it seem impossible for a septicemia to develop as a result of the normal circulation of lymphor of the penetration of the walls of capillary blood-vessels of an infected gland. Once such a condition is established there is nothing to prevent the glands throughout the body in participating in the general degenerative changes which are found in plague to affect all the cells of the body.
Looked at in this light one would expect the greatest degenerative changes in those parts of the body which receive the greatest amount of blood in a given time.
The fact that the inguinal glands drain a larger area of skin than the axillary glands means that there is more blood supplied in the first place to the area drained by the inguinal glands than to the area drained by the axillary glands. lymph has its source in the blood-vessels.
* Op: cit., page 39,
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