6 ORIENTAL PLAGUE chap. 



the disease was not plague. Such materials in several 

 instances showed in films no microbes, agar plates made 

 with relatively large amounts remained quite free of 

 growth. In other instances the microscopic examination 

 showed abundance of cocci, chiefly diplococci in clusters in 

 and amongst the leucocytes, and, as culture test proved, 

 they were Staphylococcus pyogenes aureus ; in a few 

 instances the microscopic examination, and particularly 

 the culture test, showed streptococci — Gram-positive 

 Streptococcus pyogenes ; in one case, in which suspicion 

 was justified on clinical, less on epidemiological grounds, 

 the suppurating bubo contained crowds of bipolar bacilli, 

 which by culture were shown to be Proteus vulgaris. 



From all these facts it follows, that in cases of 

 real bubonic plague great abundance of B. pestis, i.e. of 

 Gram-negative, non-motile bacilli of the same aspect and 

 size and staining power, in the tissue of the inflamed 

 gland, and less so, but still sufficiently conspicuously, in 

 the hsemorrhagic and oedematous tissues around the 

 swollen lymph gland, is a fact, and therefore from the 

 abundance of such bacilli in the gland juice of a person 

 affected with symptoms resembling those of plague — fever 

 and bubo — the preliminary diagnosis of bubonic plague 

 may be justifiably ventured upon. The bacteriologist 

 need not, and generally does not in his preliminary 

 diagnosis, i.e. microscopic examination, rely on or know of 

 epidemiological evidence, if any, such as would point to 

 plague. Moreover, there are cases, and I have had several 

 such, where at first neither the epidemiologist nor the 

 clinician knew of all the facts concerning the case ; in such 

 instances the bacteriologist has, of necessity, to rely 

 entirely on his own analysis. In such cases the micro- 



