68 ORIENTAL PLAGUE chap. 



The abundant presence in the circulation of a virulent microbe 

 like the Diplococcus pneumonice must needs be of considerable im- 

 portance, and in the particular instance may well have caused the 

 severe constitutional illness and death. As will presently be seen, 

 the microbe was present also in the skin in the haemorrhagic spots, 

 and although it may have been so present as a result of blood effusion, 

 it might, on the other hand, by its intravascular toxin have been the 

 primary cause of the destructive (chemical) vascular change leading 

 to the haemorrhage. It is well known that many microbes have such 

 an (vascular) angiolytic action; as, for instance, all the pathogenic 

 microbes which grow and multiply within the circulation, such 

 as the whole group of bacilli causing haemorrhagic septicaemia. 

 To these must be added the Bacillus pestis, the B. anthracis, the 

 Diplococcus (lanceolatus) pneumonice (when injected into the vascular 

 system 1 ), and as well some species of streptococcus and some virulent 

 species of Bacillus coli (e.g. bacillus of aerobic malignant oedema, 

 bacillus of Gaertner, bacillus of Danysz, and others). The destruction 

 (chemical solution) of the wall of minute blood-vessels by the toxins 

 of many microbes growing and multiplying within the circulation is 

 indeed a well-known fact, and accordingly the haemorrhage in the 

 skin of Nurse T. may have been due to the copious presence of the 

 Diplococcus pneumonice within the circulation. 



The questions, therefore, that arise in connection with this case 

 are these : If this was really a case of small-pox, was the presence of 

 the Diplococcus pneumonice the cause of the haemorrhagic condition ? 

 and is it also the cause of the haemorrhagic condition in other cases of 

 small-pox 1 



Before proceeding to seek for an answer to these questions it is 

 necessary first to supplement the bacterioscopic analysis of the case 

 of Nurse T. 



The Diplococcus pneumonice present in this case in the blood (see 

 film specimens and culture plate) in enormous numbers was not the 

 only microbe found therein. In the film specimens of the blood 

 now and again, but on the whole very sparsely, there were found 

 single microbes without capsule, which on more careful examination 

 were recognised as oval bacilli. On the agar plate, too, above 

 mentioned, which had uncountable translucent small grey colonies 



1 The Diplococcus pneumonice seems to be capable of causing vascular disruption, 

 even when growing outside, but close to, capillaries, e.g. the haemorrhage into the 

 exudation of the alveoli of the lung in acute croupous pneumonia causing the 

 "rusty sputum." 



