102 



GROUP III. PRIMARY BUBONIC PLAGUE WITH SECONDARY 



PLAGUE PNEUMONIA. 



Case No. IC. Asibulatory Plague, ob Pestis Minor. 



It has been known for many years, long before the specific bacillus 

 had been discovered, that plague cases exist in which the symptoms 

 are very mild and in which the patient may be free from any 

 marked elevation of temperature. These have been called ambu- 

 latory plague or pestis minor and have quite properly been compared 

 to typhus ambulatoria. 



Griesinger, Liebermeister, Montague-Lubbock, Manson, Scheube, and 

 others have called attention to the fact that such ambulatory cases, in 

 spite of the mild character of their symptoms, are liable to sudden collapse 

 and fatal termination. Manson (Tropical Diseases, 3d edition, London, 

 1903, p. 249) speaks of this type as abortive or larval plague, and states 

 that certain epidemics are distinguished by a larger proportion of mild 

 cases. "In such," he says, "buboes form and suppurate or resolve, the 

 associated constitutional symptoms are comparatively mild or perhaps 

 altogether wanting. In every epidemic there may be cases in which 

 the patient is able to be about, having little, if any, fever, and apparently 

 being little inconvenienced by the disease. Such cases, however, may 

 collapse suddenly." 



However, there is very little to be found in literature showing that a 

 more careful investigation of this type of cases has been made. So scanty 

 is our knowledge that the extensive report of the Indian Plague Com- 

 mission has no more to say about the pathology of pestis minor than 

 the following (Vol. V, p. 432) : "Death from pestis minor probably never 

 occurs, but, at any rate, no description of the pathology of plague deals 

 with this type." 



The case to be rejDorted as an example of ambulatory plague 

 demonstrates that the term "pestis minor" is a misnomer, when 

 applied to such "walking-plague patients" as die suddenly. In 

 our case the necropsy and the microscopic examinations furnished 

 evidence sufficient to account for the unexpected death in the 

 absence of any marked previous subjective symptoms of ill health. 

 The history and the findings in this case, which is somewhat com- 

 plicated by a simultaneous, evidently very recent^ tuberculosis of 

 the lungs, were as follows : 



The death of a Filipino lad, 17 years old, was reported to the 

 Santa Cruz board of health station, Manila, P. I., on February 

 27, 1904, at 11 o'clock a. m. The body of the deceased was found 

 in a dimly lighted loft in the corner of a lower unpaved room, 

 adjoining a soda-water factory at No. 185 Calle Misericordia. On 



