488
The following types of the disease were met with during 1904 :—
Pestis Bubonica.
Left Femoral Bubo, Right Femoral Bubo, Right Axillary Bubo, Left Axillary Bubo, Right Inguinal Bubo, Left Inguinal Bubo, Right Cervical Bubo, Left Cervical Bubo, Right l'arotid Bubo,
Left Sub-maxillary Bubo,
Right Iliac Bubo,
Right and Left Femoral Buboes,
Right and Left Axillary Buboes,
55
51
21
20
8
6
4
3
1
1
I
1
1
1
1
..112
25
312
Right Femoral and Left Axillary Buboes,....
Right and Left Femoral and two Cervical Buboes, Pestis Septicæmica,.
Pestis Pneumonica..
་
Total,
The frequency of the different types of the disease during the epidemic may be expressed as follows:-
Pestis Bubonica,
Septicæmica, Pneumonica,..
+1
56%
36%
8%
From the foregoing table, it is evident that the largest number of bubonic types of the disease possessed only one bubo. Those of the femoral and axillary regions account for by far the largest number of cases. The buboes have no pre- ference for either side of the body.
In 4 cases more than one bubo was found. Of these, 3 cases showed double buboes; one was a case of multiple bubo formation.
The presence of double and multiple buboes is of great interest in regard to the paths of infection of the disease. As I mentioned in my Special Report on Plague, buboes must be regarded as secondary, and in all probability are depend- ent upon the micro-organism itself, its virulence, and the individual disposition of the person or persons attacked. It is unlikely that an individual would be inoculated with the plague virus in both legs, and in this way have a right and a left femoral bubo. Again, how are we to explain the occurrence of several buboes? For instance, the presence of a right and left femoral bubo with two cervical buboes in addition, does not look like a question of skin infection.
It would appear, rather, that the plague virus possesses a marked affinity for lymphatic tissue, and that this tissue is one of the first to be affected in plague.
In no case during the past year have I found evidence of abrasion, ninute wounds, etc., which would account for the formation of the bubo.
The following table indicates the relative frequency of the different types of plague during the epidemic:-
Bubonic.
Pneumonic.
Month.
Septicamic.
Total.
January,
February,
1
Mareb,
1
ཀ།
3
3
April,
14
5
19
May,
48
29
1
78
June,
67
42
13
122
July,
35
27.
1
63
August,
4
6
2
12
September,.
5
1
2
October,.
- 1
November,.
}
1
December,
1
1
Total,............. 175
112
25
312