VIII, B. 6 Schobl: Plague in Manila in 1912 413 



positive blood culture in 40 per cent; Calvert in Manila in 100 

 per cent when examined twenty-four hours before death; 

 Choksy, Berestneff, and Mayr in 45 per cent; and Greig 

 in 60 per cent. The Indian Commission examined 28 pa- 

 tients, and obtained positive blood cultures in 16 out of 23 

 fatal cases. Not a single positive blood culture was obtained 

 from the patients who survived. Tne time of blood examina- 

 tion in positive cases was three and one-half to seventy-five and 

 one-half hours before death. The amount of blood used was 1 

 cubic centimeter. Only 6 out of the 30 samples, which gave 

 positive blood culture, were found positive by microscopical 

 examination of blood smears. The following conclusions are 

 based on these observations in regard to the septicemic stage 

 of bubonic plague: (1) "A severe septicsemia may be present 

 at a comparatively early stage of the disease and for a consider- 

 able number of hours before death, and (2) the septicaemia may 

 be of an irregular and fluctuating type." * 



From the tables it will be seen that out of 15 patients examined 

 by me, 14 gave positive blood culture; and of these 3 recovered. 

 One blood culture revealed the presence of streptococcus in addi- 

 tion to Bacillus pestis. The results of the examinations tabulated 

 in Tables I and II show, in agreement with the findings of the In- 

 dian Commission, the occasional early occurrence of plague bacilli 

 in the blood stream, as the time of examination in the positive 

 cases varied from one hour to one hundred six hours before death. 

 In consideration of the ephemeral character of the septicsemic 

 stage of plague, as evidenced by repeated blood cultures in the 

 three patients who recovered, one can hardly avoid the impression 

 that there is a certain degree of septicsemia in every case of 

 plague. The possibility of detecting the bacillus in the cir- 

 culating blood increases in proportion with the quantity of 

 blood used for culture. The best chance to recover plague bacilli 

 from the circulating blood seems to be in the stage of high fever 

 and general prostration. 



The phenomenon of agglutination of plague bacilli by the 

 serum of patients was first observed by Wissokowitsch and 

 Zabolotny in 1897 * and later confirmed by the German Plague 

 Commission. Vagedes, Klein, and others * pointed out the 

 defects of the reaction as a diagnostic means. Aside from the 

 technical diflSculties, the reaction was found inconstant, and its 



'Ibid. (1907), 7, 395. 



* Referred to in KoUe und Wassermann. Handbuch der pathogenen 

 Mikroorganismen (1903), 2, 524. 



