396 THE ETIOLOGY OF TROPICAL DISEASES 



Directions for Obtaining and Forwarding for Bacterioscopic Examina- 

 tion Material from Suspected Plague Cases 



A. From the Living Person. 



1. Clean with soap and water, and then with alcohol, the last phalanx of either 

 the second or third finger. When dry, or after mopping with a clean cloth, put a 

 piece of tape round the proximal end of the last phalanx, so as to cause venous con- 

 gestion. Prick the palmar surface of this phalanx with a sterile needle, and 

 immediately take up the exuding blood in two sterile capillary tubes such as are 

 used for collecting vaccine lymph. These tubes when charged should be sealed at 

 both ends. 



2. When there is a discharging bubo, collect fluid therefrom in capillary tubes, as 

 in the case of blood. When this discharge is not of a sufficiently fluid character for 

 collection in this way, place some of it in a small glass-stoppered phial, previously 

 well washed out with alcohol, care being taken that no alcohol remains in the 

 phial. 



3. If expectoration be obtainable, collect some in a phial in the manner pre- 

 scribed in section 2. 



[In blood, discharge, or expectoration, cover glass preparations should be made 

 and stained by simple stains, and by Gram's method. The plague bacillus does not 

 stain by Gram's method. Cocci, streptococci, and diplococcus pneumonia do stain 

 by Gram's method. Cultivations and inoculations must also be made.] 



B. From the Dead Body. 



1. Cut out any inflamed lymph gland, together with some of its surrounding 

 tissue, and place the whole in a wide-mouthed glass-stoppered bottle previously 

 well washed out with alcohol, care being taken that no alcohol remains in the bottle. 

 The bottle should have the stopper well secured and sealed. 



2. Obtain also a piece of the spleen, dealing with it in the same manner. 



All suspected plague material should be carefully packed, so as to avoid risk of 

 breakage. 



4. Leprosy 



This ancient disease is said to have existed in Egypt 3500 

 B.C., and was comparatively common in India, China, and even in 

 parts of Europe 500 B.C. We know it has existed in many parts 

 of the world in the past, in which regions it is now extinct. Some 

 of the earliest notices we have of it in this country come from 

 Ireland, and date back to the fifth and sixth centuries. Even at 

 that period of time also various classical descriptions of the disease 

 had been written and various decrees made by Church councils to 

 protect lepers and prevent the spread of the disease, which was 

 often looked upon as a divine visitation. In the tenth century 

 leprosy was prevalent in England; it reached its zenith in the 

 thirteenth century, or possibly a little earlier, and declined from 

 that date to its extinction in the sixteenth. But even two hundred 

 years later leprosy was endemic in the Shetlands, and it is recorded 

 that in 1742 there was held a public thanksgiving in Shetland on 

 account of the disappearance of leprosy. The last leper living in the 

 Shetlands was admitted to the Edinburgh Infirmary in 1798. 



