(20)
be made.
For this purpose material from the bottom and the sides of the tubes should be taken. Often in the primary cultures, and almost always in the secondary cultures, the bacilli are to be found.
Pus from the buboes, examined microscopically and by cultivation experiments, was found in most cases to contain plague bacilli in small numbers; in addition sometimes bacterium coli, and usually staphylococci. In some cases, microscopical and bacteriological examination, the pus from the buboes proved perfectly sterile.
(21)
# V-PROGNOSIS
190
Owing to the high mortality of plague, the prognosis is always grave. The course of the case showed that the height of the fever could not be regarded as indicative of the severity of the case, which depended rather on the infection or intoxication of the body with the plague bacilli.
The necrotic glandular masses in the interior of the buboes, examined by the microscope and by culture experiments, were found always to contain bacilli growing in the lymphatic and blood vascular systems.
If all the methods of research here described give a negative result, the conclusion may be drawn with considerable confidence that the case is not one of plague, or that the disease has entirely passed away.
The extent and site of the external glandular affection, like the local lesions of other infectious disorders, were not significant of the intensity of the symptoms. For, on the one hand, cases occurred with a severe course and fatal termination in which there was no externally perceptible affection of the lymphatic glands; and, on the other hand, cases with a mild course and ending in recovery though large buboes appeared.
If the patient survives the first febrile stage, which usually lasts from six to ten days, there is great hope of recovery. In many cases, however, this hope proves delusive, because in the later course of the disease, owing to the commonly occurring suppuration of the buboes, or to other complications, such as abscesses of all kinds, pneumonia, etc., fever re-appears, this time of a pyæmic or septicæmic character, and often proves fatal.
The onset of suppuration of the buboes is therefore not to be regarded as in itself a favourable sign, but merely as a sign that the patient has outlived the first stage of acute fever, and that he may hope to recover if during the further course of the disease he remains free from fever and complications. Those cases are to be regarded as more favourable in which at the end of the stage of acute fever the glandular swellings undergo resolution. But even in these cases, death occurs now and again quite unexpectedly, due no doubt to exhaustion of the system or to intoxication with the products of disintegration of the bacilli.
Plague bacilli were found in the blood of two patients ten days after the end of the first stage of acute fever, in the urine of various patients with and without buboes four to six weeks after the fever and in the fæces and the saliva five days after the fever. In blood obtained by puncture of the connective tissue of bubonic swellings, plague bacilli could sometimes be detected four to six weeks after the onset of the disease, and in one case even at the end of ten weeks. Frequently the bacilli found at this late period had nearly or completely lost their virulence.
Great dyspnœa, petechiæ, violent delirium, hæmaturia, suppression of urine, profuse diarrhoea (especially when the stools are bloody), are very unfavourable signs. Well-marked remissions after the stage of acute fever, with unclouded sensorium and a natural expression of countenance, are of favourable significance. A healthy state of nutrition and a powerful heart are valuable aids in fighting the disease.
Relapses were never observed.
( 20 )
be made.
For this purpose material from the bottom and the sides of the tubes should be taken. Often in the primary cultures, and almost always in the secondary cultures, the bacilli are to be found
Pus from the buboes, examined microscopically and by cultivation experiments, was found in most cases to contain plague bacilli in small numbers; in addition sometimes bacterium coli, and usually staphylococci. In some cases, microscopical and bacteriological examination, the pus from the buboes proved perfectly sterile.
(21)
V-PROGNOSIS.
190
Owing to the high mortality of plague, the prognosis is always grave. The course of the ease showed that the height of the fever could not be regarded as indicative of the severity of the case, which depended rather on the infection or intoxication of the body with the plague bacilli
The necrotic glandular masses in the interior of the buboes, cxamined by the microscope and by growing in the lymphatic and blood vascular systems. culture experiments, were found always to contain bacilli.
If all the methods of research here described give a negative result, the conclusion may be drawn disorders, were not significant of the intensity of the symptoms. For, on the one hand, cases occur- The extent and site of the external glandular affection, like the local lesions of other infectious with considerable confidence that the case is not one of plague, or that the disease has entirely passured with a severe course and fatal termination in which there was no externally perceptible affection
away.
Plague bacilli were found in the blood of two patients ten days after the end of the first stage of acute fever, in the urine of various patients with and without buboes four to six weeks after the fever and in the fæces and the saliva five days after the fever. In blood obtained by puncture of the connective tissue of bubonic swellings, plague bacilli could sometimes be detected four to six weeks after the onset of the disease, and in one case even at the end of ten weeks. Frequently the bacilli found at this late period had nearly or completely lost their virulence.
of the lymphatic glands; and, on the other hand, cases with a mild course and ending in recovery though large buboes appeared.
If the patient survives the first febrile stage, which usually lasts from six to ten days, there is great hope of recovery. In many cases, however, this hope proves delusive, because in the later course of the disease, owing to the commonly occurring suppuration of the buboes, or to other com- plications, such as abscesses of all kinds, pneumonia, etc., fever re-appears, this time of a pyæmic or septicamic character, and often proves fatal.
The onset of suppuration of the buboes is therefore not to be regarded as in itself a favourable sign, but merely as a sign that the patient has outlived the first stage of acute fever, and that he may hope to recover if during the further course of the disease he remains free from fever and complications. Those cases are to be regarded as more favourable in which at the end of the stage of acute fever the glandular swellings undergo resolution. But even in these cases, death occurs now and again quite junexpectedly, due no doubt to exhaustion of the system or to intoxication with the products of disin- tegration of the bacilli.
Great dyspnea, petechiæ, violent delirium, bæmaturia, suppression of urine, profuse diarrhoea (especially when the stools are bloody), are very unfavourable signs. Well-marked remissious after the stage of acute fever, with unclouded sensorium and a natural expression of countenance, are of favourable significance. A healthy state of nutrition and a powerful heart are valuable aids in fighting the disease.
Relapses were never observed.
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