STUDIES ON PNEUMONIC PLAGUE AND PLAGUE 

 IMMUNIZATION. 



V. CLINICAL OBSERVATIONS. 



By Richard P. Strong and Oscar Teague. 

 {From the Biological Laboratory, Bureau of Science, Manila, P. I.) 



CONTENTS. 



Types of the Disease Met with During the Manchurian 



Epidemic. 

 Symptoms. 

 Physical Signs. 

 Diagnosis. 

 Prognosis and Treatment. 



TYPES OF THE DISEASE MET WITH DURING THE MANCHURIAN 



EPIDEMIC. 



The cases throughout the epidemic were almost entirely those 

 of primary pneumonic plague, only two or three undoubted cases 

 of primary bubonic infection having been reported at the Inter- 

 national Plague Conference.^ However, in a number of instances 

 death occurred before there were any clinical manifestations 

 that pneumonic plague was present, and in some of these cases 

 only at necropsy was it discovered that early involvement of the 

 lungs existed. This led to the belief that many of the cases were 

 primarily septicsemic in character. One observer at the Con- 

 ference, Doctor Christie,- estimated from a clinical standpoint 

 that about 5 per cent of the cases was of the septic?emic variety 

 without pneumonia. However, from the post-mortem studies 

 made during the epidemic, we must conclude that the cases with 

 no involvement of the lungs were exceptional ones. Neverthe- 

 less, in a few instances in which infection did not occur by 

 inhalation but probably through the tonsils or the mucous 

 membranes of the mouth or throat, it seems unquestionable that 

 the lungs were either not involved or only very slightly so. Thus, 



' Report of the International Plague Conference held at Mukden, April, 

 1911. Manila (1912), 428. 



' Ibid., p. 166. 181 



