Sessional_Paper_1906 — Page 460

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into the tissues and around the lymphatic glands and also under the serous membranes, retroperitoneal, sub-epicardial, &c. In the females there was intense congestion of the endometrium and of the mucous membrane of the Fallopian Tubes.

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The mortality rate w s for males 80 per cent., for females 85 per cent., with a total percentage of deaths about 82 per cent.

Mortality with reference to Variety.

Of the Bubonic variety 85 per cent. died, of Septic cases 60 per cent. It will be noticed that the Bubonic variety was more fatal.

Mortality with reference to Age Period.

The discase is equally fatal at all age periods.

Presence of Bacilli in the Blood as a means of Diagnosis.

Last year I drew attention to the fact that the presence of the Plague bacilli in the peripheral blood was somewhat capricious and that their absence could not be held to negative a diagnosis of Plagne in the presence of symptoms. I have again this year made an investigation into this subject and have carefully examined the peripheral blood in 28 cases. I found that in the Bubonic variety the bacillus pestis was absent from the peri- pheral circulation in 15 cases, and present in 8 cases, and in the Septic variety the bacillus was absent in 3 cases and present in 2.

It is also noticeable that the bacillus pestis cannot always be found in the peripheral blood immediately preceding death. I paid special attention to the examination of the blood of the cases that died. I was able to find the bacillus in 8 cases, and was satisfied that they were absent in 19 cases. These were all typical cases of Plague, for an anatomical examination was made in each case and diagnosis confirmed.

Spleen Puncture as an aid to Diagnosis.

The presence of the bacillus pestis in the peripheral blood thus not being always to be counted upon and consequently not being always available as a means of diagnosis, I have in a certain number of cases which were doubtful employed spleen puncture. The bacilli are not, however, always present in the spleen. Thus in an examination of 25 cases very shortly after death the bacillus pestis was present in the spleen in 16 cases, and could not be found in 9 cases. In spite of this, however, I consider that a combination of the two methods of examination enable a satisfactory opinion to be formed.

Focus of Infection.

In the very large majority of cases we are unable to point with clear evidence to a focus of infection, but knowing Plague to be an infectious disease we are driven to conceal our ignorance by the term cryptogenous infection. In the following four cases I was able to trace what I considered to be a focus of infection :-

(1.) Male.-Right Femoral Bubo. Patient has two or three small pustules on shin which on examination were found to be crowded with Plague bacilli. This patient died.

(2.) Male.-Right Axillary Bubo. There was a small necrotic patch about the size of a shilling a little outside and in a line with right nipple. This was caused by an injury, plague bacilli were found in it, and the bubo developed two days after. Patient recovered.

(3.) Female.-Right Femoral Bubo. A large vesicle was found in 2nd right toe,

in which Plagne bacilli were found. Death.

(4.) Male.-Right Femoral Bubo. Vesicles were found over right shin and plague

bacilli were found. Patient died.