378
While therefore one would expect the glands throughout the body to shew degenerations and changes characteristic of plague when once a septicemia is established, one would not expect the axillary glands to shew so great changes as would the inguinal glands should the infection have entered through the skin within the area of skin drained through these latter glands.
When all the points which I have touched upon above are considered, I think it will be generally agreed, that the theory of skin, innoculation as the most fre- quent node of entry of the bacillus into the tissues of the body, is not founded on such a slender basis as Dr. HUNTER has affirmed.
Infection through the Alimentary Tract.
The question whether plague could be induced by the eating of infected material is one which has probably been asked by all workers in this field.
The question is naturally suggested by the frequent early appearance of symptoms of disturbance of the digestive functions in a plague patient. These symptoms do not occur alone but are a part of the symptoms of disturbance of the functions of the cells of the body generally.
Nevertheless the question is an important one and the Government Bacterio- logist* holds the view that infection through the gastro-intestinal tract is the most important mode of infection in this disease.
Support for this view is sought for (1) in the frequently observed fact that in plague there is generally a condition of congestion and degenerative changes in the lymphatic glands throughout the body; (2) that the lymphatic glands within the abdomen frequently show more marked changes than do superficial glands; (3) that there are found on post-mortem examination marked evidences of degenerative change in the gastro-intestinal tract and the abdominal viscera generally, as evi- denced also in the experiments conducted by Professor SIMPSON in Hongkong in 1902 and published in his report on the Causes and Continuance of Plague in Hongkong (1903).
With regard to the first point, namely, the presence of congested and degene- rating glands throughout the body, I have, under the heading Infection through the Skin, given reasons for not considering this to be evidence of anything more than the existence of a plague septicemia which may result from an inoculation through the skin. I cannot see any reason in bringing this point forward as evidence of gastro-intestinal infection as opposed to skin infection.
As for the second point, namely, that the lymphatic glands within the abdo- minal cavity frequently shew more marked changes than do other glauds, I cannot accept this as evidence in support of the gastro-intestinal theory of infection, on the following grounds.
The coeliac and mesenteric glands while participating in the changes affecting the tissues generally might be expected to shew even more marked changes than the generality of glands if the entrance of the bacillus had been by another channel than the gastro-intestinal tract.
Once a septicemia is established those organs of the body which receive the greatest amount of blood in a given time or which at some particular time receive a specially large supply of blood to subserve some special function, night reaso- nably be expected to shew more effects from the action of the parasite than other less vascular organs or tissues.
The abdominal viscera are highly vascular organs and during the process of digestion, i.e., after each meal the circulation of blood through these organs is greatly increased.
It is the usual custom amongst the classes who are most attacked by plague in this Colony to take two meals a day. Twice each day therefore will the abdo- minal viscera receive a specially large supply of blood to subserve this special process of digestion.
*Op. cit., page 40.