Plague / Its Cause and the Manner of its Extension, Its Menace, Its Control and Suppression, Its Diagnosis and Treatment

by Thomas Wright Jackson

[Table I.]—Examination of Fatal Cases of Plague

Patient		Race	Sex	Age	Date of examination		Duration of illness	Hours before death	Bubo			Blood		Skin			Sputum
									Smear	Culture	Animal inoculation	Culture	Agglutination	Smear	Culture	Animal inoculation	Smear	Culture	Animal inoculation
				Years	1912		Days
1.	Sing Nu	Chinese	Male	(?)	July	11	5	48	+	+	+	0	0	+	+	+	-	-	-
3.	Aluncion Raymundo	Filipino	Male	15	Sept.	29	3		+	+	+	0	0	0	0	0	0	0	0
4.	Filo Almalas	Filipino	Male	39	Oct.	10	4	22	+	+	+	+	-	+	+	+	0	0	0
6.	Polycarpio Guzman	Filipino	Male	34	Oct.	22	2		+	+	+	0	0	0	0	0	0	0	0
7.	José Sarmiento	Filipino	Male	37	Oct.	22	3		+	+	+	0	0	0	0	0	0	0	0
8.	Julian Gonzales	Filipino	Male	41	Oct.	22	3	23½	0	0	0	+	-	0	0	0	+	+	+
9.	Valeriano Buencamino	Filipino	Male	31	Oct.	22	3	10	+	+	+	+	-	0	0	0	0	0	0
10.	Pedro Nicomedes	Filipino	Male	30	Oct.	22	2	5¾	+	+	+	+	-	0	0	0	0	0	0
12.	Regino Gulano	Filipino	Male	34	{Oct.	22	2	106	0	0	0	+	-	0	0	0	0	0	0
					{Oct.	24	4	82	0	0	0	0	0	0	0	0	+	+	+
13.	Martin Dimalanta	Filipino	Male	35	Oct.	23	3	25½	+	+	+	+	-	0	0	0	0	0	0
14.	Roberto Obiso	Filipino	Male	25	Oct.	23	1	53	+	+	+	+	-	0	0	0	0	0	0
15.	Juan Barceta	Filipino	Male	23	Oct.	24	3	37	+	+	+	+	-	0	0	0	0	0	0
16.	Yu Tum	Chinese	Male	14	Oct.	24	2		+	+	+	0	0	0	0	0	0	0	0
17.	Augustin Monterey	Filipino	Male	29	Nov.	1	1	27	+	+	+	+	-	0	0	0	0	0	0
18.	Demetrio Pabraw	Filipino	Male	27	Nov.	23	4	15	0	0	0	+	-	+	+	+	0	0	0
21.	Ambrosio Sobremonte	Filipino	Male	20	Dec.	7	6	1	+	+	+	+	-	0	0	0	0	0	0
22.	Mateo Marcelo	Filipino	Male	8	Aug.	20	(?)		-	-	-	0	0	0	0	0	0	0	0
23.	Alejandro Gita	Filipino	Male	[A]17	Nov.	24	3		-	-	-	0	0	0	0	0	0	0	0

[A] Months.

[Table II.]—Examination of Plague Patients Who Recovered

Patient		Race	Sex	Age	Date of examination		Duration of disease	Bubo			Blood
								Smear	Culture	Animal inoculation	Culture	Agglutination
				Years	1912		Days
					{Sept.	29	2	-	-	-	0	0
					{Oct.	2	5	+	+	+	0	0
2.	Dionisio Capate	Filipino	Male	18	{Oct.	3	6	0	0	0	-	+1:16
					{Oct.	7	10	-	-	-	0	0
					{Oct.	15	18	-	-	-	-	+1:64
5.	Alejandra Fisher	European	Female	6	Oct.	20	7	+	+	+	0	0
					{Oct.	22	2	+	+	+	+	-
					{Oct.	24	4	+	+	+	0	0
11.	Gabriel Sevilla	Filipino	Male	21	{Oct.	26	6	0	0	0	-	+1:16
					{Nov.	8	18	-	-	-	0	0
					{Nov.	15	25	-	-	-	-	+1:64
					{Nov.	26	3	+	+	+	+	-
					{Dec.	6	13	0	0	0	-	+1:32
19.	Esteban Roa	Filipino	Male	15	{Dec.	16	23	-	-	-	-	+1:60
					1913
					{Jan.	11	48	-	-	-	-	+1:120
					{Dec.	2	(?)	+	+	+	0	0
20.	Sia Su	Chinese	Male	35	{Dec.	5	-	0	0	0	+	-
					{Dec.	16	-	-	-	-	-	+1:80
24.	Purificacion del Val	Filipino	Female	19	{Dec.	11	3	+	+	+	0	0
					{Feb.	11	33	-	-	-	0	0

Note.—The bubo in Nos. 2, 5, and 24 never opened spontaneously. The pus was aspirated at the time of the second, eventually third, examination. Nos. 11 and 19 opened spontaneously. A fistula formed along the canal which was caused by the puncture, and healed up in several weeks. Hard inguinal buboes of secondary order persisted in patient 19 at the time of second examination. No plague bacilli were found either in the bubo of the first or second order. Patient 20 had a considerable amount of pus in the inguinal primary bubo, but it was not opened until after the last examination. made from the swelling on the neck of patient 23 revealed the presence of pneumococci. Both patients died of plague, as was ascertained by examination of the organs after death.

Two of the patients, cases 8 and 12, had numerous plague bacilli in the sputum at the time when the expectoration showed the presence of blood (twenty-three and one-half and eighty-two hours, respectively, before death). In 3 cases I was able to prove the presence of Bacillus pestis in the skin lesions, intra vitam, fifteen, twenty-two, and forty-eight hours, respectively, before death. In case 18 there was no doubt that the skin lesions, which covered the whole body and the face, were of secondary nature, as the patient died shortly afterward. It was undoubtedly a case similar to those reported by Gotschlich and Zabolotny.[5] In the other two patients there was only 1 maculopapulous efflorescence on the foot in case 1 (with a corresponding femoral bubo) and 2 lesions of the same type on the arm and forearm in case 4 (with a corresponding axillary bubo). It is possible that these lesions were the original port of entry of infection. Numerous plague bacilli were found in the skin lesions of these cases, both microscopically and in culture.

[5] Kolle und Wassermann: Handbuch der pathogenen Mikroorganismen. Gustav Fischer, Jena (1903), 2, 521.

The plague patients tabulated in [Table II] recovered. They were all treated with antiplague serum. While cases 5, 11, 19, and 24 appeared clinically to be rather severe, cases 2 and 20 were mild.

It can be seen from the [table] that the plague bacilli may not be detected in the enlarged gland at first (case 2) and that their presence may be revealed only after repeated examination of the bubo. It is also evident from the results of repeated examinations that the plague bacilli disappear from the infected gland in a comparatively short time, as a rule at the time when pus starts to form. Contrary to the findings in patients who died, distinct phagocytosis was noticed in the smears made from the aspirated liquid in those patients who recovered and who had been treated with serum soon after the onset of the disease. It is undoubtedly this process that clears the gland of the infectious agents.