Sessional_Paper_1897 — Page 455

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DISTRIBUTION OF WORK.

The work in connection with the outbreak of Plague was distributed as follows:-

cases

The Sanitary Board undertook all duties in connection with the removal of plague to the hospital, the subsequent isolation or temporary removal of those who had been in immediate contact with the disease, the disinfection of the premises, the clearing and the cleansing of the declared districts.

The Medical Department undertook the care of the sick after their removal to hospital, and The Public Works Department undertook the erection of the necessary temporary buildings, the preparation of graves and the interment of the deceased.

The Sanitary Board staff was augmented by the appointment of Dr. CLARK, Medical Officer of Health, and by the loan of 44 Police and 45 Soldiers.

The Medical Department was augmented by the loan of Dr. WILM of the Imperial German Navy.

MEDICAL.

The Pathology, symptoms and morbid anatomy have been so fully described elsewhere more particularly in Dr. Lowson's Report on the Plague in 1894 and in Dr. WILM's Report for 1896 that I will only refer to certain facts that our experience in 1896 bas elicited.

Pathology.-The main Channel by which the bacillus gains access to the body appears to be by the Digestive tract.

In most cases the mucusmembrane of the alimentary tract, from the stomach downwards, has been found distinctly hyperemic, the membrane being thickly coated with mucus and presenting petechiæ and inflammatory patches. The mesenteric and retroperitoneal glands in all cases were inflamed and in many cases surrounded by sanguineous effusion, the gland tissue itself being softened and crowded with plague bacilli.

In many of the cases these were the only post mortem appearances to be found.

Rats, Mice, Monkeys, Pigs and Fowls have been proved to have acquired plague after having been fed with fragments of organs of animals that have died of the disease.

The faces of those attacked undoubtedly contains the specific bacilli.

Infection by the skin (inoculation) occurs but very rarely, if this were the frequent mode of infection we should find more often inflammatory affections of the skin, as when animals are infected with the poison subcutaneously well marked inflammatory changes at the seat of inoculation always

occur.

Again the external glandular affections from which the disease derives its name are not met with as a rule until some three or four days after the period of invasion.

If infection by the skin is the rule one would expect, as Dr. WILM has pointed out, that axillary buboes would be quite as common as inguinal ones, this however is not the case.

As against the theory that the channel of reception of the bacillus is the respiratory tract (i. e. infection through air) may be adduced the immunity of those who attended the patients and of the Sanitary Staff who superintended and were engaged in the inspection and disinfection of the infected houses.

The plague bacillus has not been detected in the air, many examinations were male of the air of the wards at Kennedy Town Hospital but always with negative results, the bacillus also does not survive desiccation.

The main channels of infection therefore appear to be the digestive tract and the skin.

It has also been proved that in addition to the faces the bacillus leaves the body by the urine. Culture experiments of the urine frequently demonstrated the presence of the bacillus.

In 95% of the cases albumen was found in the urine varying in amount from one tenth to a half.

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SYMPTOMS.

Incubation. Although the period of incubation appears to be generally from three to five days, one case at the Gaol in 1896, as narrated by Dr. WILM, gives a period of fifteen days.

Plague without buboes.—In 1896 many cases occurred without the formation of buboes, during the height of the epidemic the percentage of these cases was 20 and towards the end as high as 27.

In all cases the disease was diagnosed as plague by demonstrating the presence of the bacillus in the blood or by culture experiments of the blood, faeces or urine.

TREATMENT.

With reference to treatment the general plan was to allow in the Hospitals ample room and free ventilation.

The strength of the patient was maintained as far as possible with beef-tea, chicken broth and brandy, milk and eggs, if the patient could be kept alive for a week, his case was considered a more hopeful one, about 70 per cent. of the deaths occurring during the first six days.