CO129-275 - Governor Sir Robinson - 1897 [1-5] — Page 188

(8)

(9)

184

increased in size, and their centres became gangrenous, so that ulcers of the size of a crown-piece were appearance of the buboes at the outset, in the acute stage of the disease, in 219 cases (73 %), was as formed, which healed very slowly. Visible wounds of the skiu existed in very few cases only; the fellows :---- were usually abrasions, and showed as a rule no inflammatory phenomena. In two cases, however small wounds on the hand and on the upper arm respectively were red and inflamed, and were the starting points of lymphangitis. In one case furunclosis was observed.

space.

*

#1

1. Unilateral inguinal or femoral buboes 2. Bilateral

3. Unilateral axillary buboes

.128 cases

10

17

21

42.6% (of 300 cases).

3.3% (

22

}

33

11% (

4. Bilateral

0

0% (

3)

32

10.7% (

3

1% (

>>

3

3

1% (

11

0

0% (

፡፡

37

2

17

0.7% ( 2.7% (

>

5. Unilateral buboes in the neck

6. Bilateral

""

وو

>!

7. Unilateral sub-maxillary buboes

8. Bilateral

9. Unilateral buboes in the region of the elbow 10. Buboes in various parts of the body......... 8

In the $1 patients (27%) not affected with buboes, there could usually be felt in one or more parts of the body painless or more or less painful glandular swellings up to the size of a hazel-nut.

In the six Europeans affected, there appeared at the beginning of the disease :-—

1. Unilateral inguinal buboes

........3 cases

50% (of 6 Europeans),

2. Buboes appearing simultaneously in various

parts of the body

1

15

17 % (

}

"

33 % (

"

3. Small, painless glandular swellings up to the

size of a hazel-nut

Age, sex, and occupation had no particular influence on the course or seat of the buboes, as is shown by the following table :-

Outwardly visible swellings of the lymphatic glands were among the most constant and char teristic phenomena of the discase. They appeared either at the beginning of the fever, or, much more commonly, in the course of the first six days, and were very various in size and character. 73% of the cases, in one or more parts of the body, buboes appeared, from the size of the pigeon's egg to that of the fist; in 27 % of the cases the glandular swellings were smaller, from a bean to al hazel-nut in size. By careful examination, moderate swelling of the glands up to the size of a bean In addition to the changes in the or a hazel-nut could usually be detected in all parts of the body. external lymphatic glands, there was swelling of the internal glands, especially of those of the intestine; the changes in these glands will be described in detail in the section on pathological anatomy. In the cases in which buboes of considerable size were formed, their most common site was the groin, and after that, in order of frequency, the axilla, the angle of the jaw, the sub-maxillary region, and the neck. In exceptional cases only were they found at the elbow or in the popliteal As a rule, a bubo appeared in one of these places only; the simultaneous appearance of buboes in the groin, the axilla, and the neck, was an occurrence of the greatest rarity. In the groin the deep-lying glands in Scarpa's space, two or three fingers' breadth below Poupart's ligament, werd usually those first affected; it was seldom that the carliest bubonic swelling occurred in the upper superficial glands, as in syphilitic bubo. Frequently, however, the superficial glands were affected o a sequel to the affection of the glands in Scarpa's space. In the axillary region also, the deeply-lying groups of glauds were those first affected. The formation of the individual buboes was usually a rapid one, accompanied by pain, and was sometimes complete in a few hours; but more commonly, if they reached the size of a pigeon's egg, of a hen's egg, or of the fist, as the case might be, their full development occupied from one to four days. Commonly the glandular swellings, especially when situated under the deep fascia and in the popliteal space, were extremely painful, so that the patient, when the inguinal or the axillary glands were affected, kept the thigh flexed or the arm adducted The inflammation usually spread from the glands first affected centripetally to other glands. To the adenitis there was as a rule soon added inflammation of the peri-glandular tissue and of the skin, so that the individual glands were no longer to be distinguished. The skin over the buboes was then red and oedematous; and an indurated, elastic, painful swelling was formed, extending often, in the case of inguinal buboes, to the middle of the abdomen and to the middle of the thigh, and in the case 189 Men of axillary buboes, to the shoulder-blade and to the sternum. At times a greater or less extent of the skin covering such buboes became gangrenous. As already stated, at the outset a single group Women of glands only was severely affected; it was rare for buboes to appear simultaneously in different places. In the later course of the disease, however, buboes and abscesses frequently appeared simu taneously in all parts of the body. The greater number of the buboes (90%) suppurated, those dating from the beginning of the disease usually breaking down in from ten to fourteen days, and requiring from one to four months to heal. Even after this, indurations frequently remained in and around the scar. Large necrotic glandular masses were often met with in the interior of the suppurating buboes. Those buboes, that did not break down, seldom subsided rapidly and completely; they usually continued to be felt as smaller or larger indurations. The percentage of cases that ra their course without the formation of buboes was, during the height of the epidemic, 20, and toward the end of the epidemic 27. The reason for the smaller percentage toward the end of the epidemi was, that the cases then became less severe, and often stopped at the formation of small, painful glandular swellings, less frequently going on to the production of definite buboes. Generally speaking the mortality among those patients with buboes and among those patients without buboes was, during the height of the epidemic, identical.

Of the 300 patients under my care at the Kennedy Town Hospital, 6 were Europeans (5 English and 1 Italian) and 294 non-European (Chinese, Indians, et cetera). Of ages from 14 to 72, 189 were males and 51 females; of children below the age of 14, there were 60. No age was exempts from the disease. 73% were affected with buboes, 27% were free from buboes. The manner

Patients suffering

from Plague.

With Inguinal Buboes.

With Axillary Buboes.

With Buboes

at the Elbow.

60 Children

Total 300 patients

96 = 51 %

With Buboes in the Neck or the Sub-Maxillary Region.

L

With Buboes in

Without Buboes but with moderate Glandular Swelling.

Various Parts of the Body,

17 = 9%

12 = 6%

2 = 1%

62 33%

21 = 41 %

9 17%

4%

9 = 18%

3 = 6%

7=14%

21

= 85%

7 = 12%

17 =

25%

3 === 5

12 = 20 %

188 = 45'9 %

33 = 11%

2 = 0·7%

38 127%

8 = 2·7%

81 - 27%

Of the six Europeans attacked, two were police-inspectors, two were the six and eight year old children of police inspectors, one was a soldier of the Rifle Brigade, and one was a sister of the Italiau Convent.

At the outset of the

The symptoms of disorder of the digestive tract were very numerous. disease the tongue usually became swollen, bright red at the tip and edges, and was covered with greyish-white fur. Usually on the second or third day of the disease, the fur became brownish or blackish and dried in a crust, and the tongue sometimes became cracked and fissured, so that it soon resembled that seen in typhus and in the third week of typhoid. The lips soon became dry, and often The appetite fissured. The mucous membrane of the mouth and pharynx was usually bright red. disappeared. There was frequently uncontrollable vomiting, and great thirst, with a painful sensation of heat in the stomach and the lower part of the abdomen. The younit was sometimes watery, some- Diarrhoea was times bilious, sometimes like coffee-grounds. Hammatemesis was not observed.