Of 4179 patients treated for plague at hospital at Poona, India, 2S30 died, the mortality being slightly greater in males than females, and distinctly lower in children. Of the fatal eases, 74 per cent. were bubonic. The non-bubonic forms, which were largely pneumonic or septic, were of the malignant class and showed high mortality,—about 75 per cent. Buboes occurred most frequently in the femoral region. The main sequels were infiltration and sloughing of the skin and necrosis of bone. Disturbance of speech was very common, particularly a peculiar drawl and inability to articu late certain words; the voice often re sembled that of a boy at the age of puberty. E. L. Marsh (Glasgow Med. Jour., Jan., '99).
In the pneumonic or septic variety there is profound septicaemia. The monary inflammation closely resembles commencing influenza (Lewin) and does not show clear physical signs. It is a form of confluent lobar pneumonia with out apparent or noticeable implication of the lymphatic system. It also begins with a chill, severe pain in the side, and more or less severe cough with rusty ex pectoration. The plague bacillus is al ways found in the latter. In this variety death may occur within twenty-four hours.
Some epidemics exhibit symptoms rep resenting both varieties.
Diagnosis. — Characteristic symptoms were noted by Lewin during the last Bombay epidemic. The sudden exhaus tion and weakness at the commencement of the disease is the first of these; no other fever, even on the first day, is characterized by such extreme debility. Neither is the moist, non-tremulous moth er-of-p ea rl-like tongue of Bulard met with in any other disease.
Besides the typical symptoms, the bubo, and examination of the sputum for the plague bacillus in the pneumonic form, examination of the blood for ba cilli, according to Abel (Centralb. f. Bakt., Apr. 24, '97), is of the greatest importance. The specific organisms have been shown by Kitasato to persist in the blood for three or four weeks after the onset of the disease. Examination of the blood, however, may be fallacious, owing to variability of the bacillus, leading to confusion with other forms. The best confirmatory evidence is the result of a broth or agar cultivation. Inoculation experiments are also advisable, and, as infection is often a mixed one, the ani mals used should have been previously subjected to "vaccination" against strep tococci. A fair quantity of blood should be used and kept at a temperature of 37° C. (98.5° F.) for ten or twelve hours be fore being cultivated. The urine prac tically always contains albumin and plague bacilli, the latter often persisting for a week after convalescence.
Plague bacilli are found in long and short forms, with an intermediate stage.
Their length appears to be inversely pro portional to the nutritional value of the culture-medium. The most character istic appearance is that of sharply and repeatedly bent chains of immobile spin dle-shaped bacteria, almost as small as cocci. They are decolorized by Gram's method, and with weak solutions of stain ing reagents show a clear space in the centre of the rod. The bacillus grows aerobically and anaerobically; it causes acid formation, but will grow in quite strongly alkaline solutions. It forms characteristic growths on agar and in bouillon. The best medium is an alka line solution of peptone containing 1 or 2 per cent. of gelatin. It is pathogenic to all the small laboratory animals with the exception of pigeons. The micro-or ganism is rapidly killed by drying at a temperature of 30° C. and upward, over concentrated sulphuric acid, but is much less affected by slow desiccation at lower temperatures. Even at the room-tem perature rapid drying is much more lethal to them than slow drying in tis sues and fabrics.
The diseases for which plague may be mistaken are typhoid fever, typhus fever, and splenic fever, and in the pneumonic variety it may at its onset be mistaken for influenza. It is distinguished from typhoid fever by its sudden onset, by the absence of the rash and the abdom inal symptoms, and in a few days by the appearance of the bubo. Typhus fever has a longer fever stage, viz.: fourteen days. The difficulties chiefly occur in the severe cases without buboes, and in the mild eases with slightly en larged glands which simulate adenitis, the so-ealled pestis minor, or pestis ambulans; in all cases, however, the diag nosis can be established by finding the characteristic bacillus. J. Milford At kinson (Lancet, Jan. 26, 1901).
For an early diagnosis of bubonic plague the most satisfactory method is that of aspiration of one of the recent swollen glands by means of a hypo dermic syringe. With the material in the syringe: 1. A drop is used to make culture in melted agar tubes or in bouil lon from which dilutions, cultures, and plates can be made. 2. A drop is allowed to fall on a slide, which is then smeared by a platinum needle, to be used for direct examination. 3. The remainder is injected into a mouse or a rat. If ex amination of the specimens on the glass slides shows the presence of large num bers of characteristic. short, bipolar staining bacilli. that decolor by Gram's method, the case at once becomes more than suspicious. By the second day the inoculated animal is either dead or very ill. and an absolute diagnosis can be made. J. J. Curry (Boston Med. and Sorg. Jour., March 21, 1901).