Residents must now do their part, and owners of property must permanently make their buildings safe for tenants, both for business and residential purposes.
Bacteriologic Observations Made by Dr. Otto Schöbl.—The following observations upon the bacteriologic aspect of the Manila epidemic which we are considering were made by Dr. Otto Schöbl of the Biological Laboratory of the Bureau of Science, Manila, and pertain to the cases of the first year of the epidemic. They were printed in the December number of the Philippine Journal of Science in 1913, but as they belong so definitely to the epidemic I am describing and as Dr. Schöbl has expressed his willingness for me to quote them in full, I gladly accept his permission. Dr. Schöbl advanced the possibilities of blood-culture diagnosis to such a point of reliability that it became practically possible for us to expect positive culture in nearly every case of true plague and the whole matter of bacteriologic diagnosis was perfected to a high degree of efficiency under his administration of the laboratory work.
He relates his observations as follows:
During the recent outbreak of plague in Manila, I had the opportunity to make certain observations which are of interest. These observations were made in the examination of: (1) Specimens taken from patients and from dead bodies at autopsies, (2) samples of blood-sucking insects collected in houses where plague patients had lived, (3) rodents caught by trap or poisoned in the parts of the city where plague cases occurred from time to time, and (4) domestic animals suspected of plague infection.
I. Bacteriological Examination of Plague Patients
In order to secure as early diagnosis as possible, the following procedure of investigation was adopted:
- The bubo was aspirated by means of a sterile hypodermic syringe. The material thus obtained was placed in the water of condensation of an agar-slant culture tube.
- At least 7 centimetres of blood were withdrawn from the cubital vein by means of another sterile syringe, and 5 centimetres of it were placed in an Erlenmeyer's flask, containing 200 centimetres of neutral meat broth. The rest of the blood was emptied into a sterile tube, and used for agglutination tests.
Cultures obtained by this method were examined microscopically, and the growths on various culture media were studied. Gram stain, Löffler's methylene blue, and hanging-drop method were used. Polar-staining and chain formation in liquid media and the characteristic type of colony on the surface of agar were looked for. Animal inoculation was performed in every case, and the culture isolated from each case was identified by agglutination test, rabbit's immune serum being used.
The results of the bacteriological examination of a series of 24 patients are tabulated in the two following tables. [Table I] includes the fatal cases and [Table II] those cases which recovered.
The diagnosis of plague could be safely made from the microscopical examination of the liquid aspirated from the bubo in the majority of the cases. However, in certain instances the amount of the aspirated fluid being small and the bacilli very few, it was impossible to diagnose the case, especially when the cultures from the bubo were negative. Repeated examination of the patient was necessary under those conditions, but it happened in cases 22 and 23 that the patients died of plague before a second examination could be made. The smears and cultures from case 22 remained sterile, while the smears and cultures