Sessional_Paper_1904 — Page 635

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PREFACE.

In forwarding this report to the Government I would mention that I have been for many years a firm believer in the fact that infection frequently occurs through the gastro-intestinal tract. I would here repeat what I stated in my report to the Government on the prevalence of Bubonic Plague in the year 1896:-

"The main channel by which the bacillus gains access to the body appears to be by the digestive tract.

In most cases the mucus membrane of the alimentary tract, from the stomach downwards, has been found distinctly hyperamic, the membrane being thickly coated with mucus and presenting petechia and inflammatory patches. The mesenteric and retro-peritoneal 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 forces of those attacked undoubtedly contain the plague bacilli,

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

Again, the external glandular affections (buboes), 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 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 respi- ratory tract (ie., infection through the air), may be adduced the immunity of those who attend the patients and of the Sanitary Staff who superintended and were engaged in the inspection and disinfection of the infected houses. The plague ba- cillus has not been detected in the air, many examinations were made of the air of the wards at the Plague Hospital but always with negative results. The plague ba- cillus also does not survive dessication.

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

In 1896 many cases occurred without the formation of buboes, during the height of the epidemic the percentage of these cases was twenty and towards the end as high as twenty-seven.

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, fœces or urine."

As regards the microscopical examination of the blood and the diagnosis oj plaque, this method was perfected last year by the examination of blood films accord- ing to Ross' method, in this way much more of the blood is examined at one time and in typical cases of the disease one always finds plague bacilli present.

Plague a Septicwmic Disease.

The reasons given in this report for considering plague a septicamic disease appear to be conclusive, they are briefly :-

(i.) The fact that by Ross' method plague bacilli are found in the blood

in living cases in considerable numbers;