Sessional_Paper_1904 — Page 649

540

of the view that the plague bacillus is more or less constantly found in the blood in plague. Skin eruptions of various kinds are frequently met with in plague. These may be of the nature of papules, vesicles or pustules. Some of these pustu- lar forms are of such a size as to resemble boils or carbuncles.

Such skin erup. tions usually appear in the following way. A small reddish or brown spot, varying in size from a pin's head to a pea, appears on the skin. It has a hot or burning feeling. The spot becomes indurated, slightly elevated, and surrounded by halo of bright red congestion. It develops into a vesicle, which also varies much in size. The contents of this are cloudy, and contain plague bacilli in considerable numbers. The vesicles soon become infected with ordinany skin micro-organisms, and the contents become pustular. The surrounding halo of congestion increases in circumference, the induration is more marked, and according to the severity of the process, the lesion may be likened to a pustule, boil or

carbuncle.

Such vesicular and pustular manifestations are by no means uncommon in bubonic or other varieties of plague. The vesicles contain plague bacilli. The pustules usually contain large numbers of ordinany pyogenic cocci. Plague bacilli which were present originally, have usually disappeared, the condition resembling that found in suppurating bubonic swellings. I regard these papular, vescicular and pustular eruptions as evidences of local growth of the B. pestis. The condition, I presume, is similar to that found in enteric fever, where the typhoid rash is the result of focal multiplication of typhoid bacilli. These erup- tions often appear scattered over the skin, and in cases where a well developed bubo is present, they have nothing to do with the point of entry of the infection. They are evidence of blood infection and support the septicamic theory of plague.

An

At the same time such eruptions may occasionally represent the point of inoculation of the plague virus. Cases of this are occasionally met with. excellent instance of the occurrence of this mode of infection came before my notice about two years ago, whilst engaged with Professor SIMPSON in carrying out an experimental research into the question of the relative susceptibility of different animals to plague.

The details of the case are as follows:--A Chinese butcher was engaged by us to assist in performing the post-mortem examinations on the experimental animals which had succumbed to plague. On one occasion, a post-mortem examination was being held on a pig which had died of severe septicemic plague. The butcher accidentally scratched the back of his right hand with the broken. end of one the ribs. The injury was slight and just-tinged with blood. It was washed, sucked and disinfected. It caused him no inconvenience at the time. He discontinued the post-mortem at once. Two days later, the man complained of sickness and diarrhea, with severe headache and general weakness. He ascribed the symptoms to malaria from which he frequently suffered. On the following day he felt hot and generally uncomfortable. The injury or scratch on the back of his right hand felt sore and burning. His right arm felt weak with shooting pains in the muscles. The scratch showed nothing particular. Very slight indura- tion was made out but this was ascribed to the effect of strong antiseptic solutions. Being suspicious of plague the man was at once isolated. Slight traces of lymph- angitis were found extending up the forearm. On the following morning a small vesicle had developed over the site of the original scratch. The surround- ing skin was red and congested and indurated. The lesion was extremely painful. The lymphangitis was more marked and had extended to the arm.

The axilla was tender, but no bubo had developed. The temperature was 102° F., the eyes congested, the tongue coated and he still complained of slight diarrhoea. The contents of the vesicle were examined bacteriologically and numerous plague bacilli found. The blood was also examined with a positive result. The man was treated in the Plague Hospital. A bubo developed in the right axilla. The original vesicle dried up under proper treatment and the lymphangitis disappeared. A few days after his admission to Hospital, several small vesicles developed on his legs.

All of these resembled the original one on the hand. All contained plague bacilli. The man presented all the symptoms and physical signs of plague in its bubonic form and died 7 days after admission of cardiac failure. Such a case is interesting from several points of view, namely:-

(a.) The exact localisation of the point of infection. (.) The pathological lesions at the point of infection.