﻿IX, B, 1 Heiser: Plague in the Philippines 7 



On the fifth day, the fever still persisted, but the patient stated 

 that he did not feel ill and demanded to be released from the 

 hospital. On this day, the expectoration was bloodstained, but 

 no suspicious organisms could be found in the smears nor could 

 any physical signs of pneumonia be detected. Furthermore, 

 there were no palpable glands. On the morning of the seventh 

 day, the temperature and pulse dropped and the general condition 

 was distinctly worse. The patient now admitted that he felt ill. 

 Several hours later, he flinched when pressure was made in the 

 right axilla. Lymphatic enlargement was now made out, and 

 by the evening of the seventh day the bubo in the axilla had 

 increased markedly in size, the swelling approximating 3 by 7 

 centimeters. Glands now became palpable in other portions of 

 the body, particularly in the cervical region, and a few hours 

 later there were inguinal and femoral buboes. The patient 

 became rapidly worse, and died at 7 o'clock on the morning of 

 the eighth day of his illness. At the necropsy, the glands of the 

 right axilla and those of the right side of the neck were found 

 enlarged; the other lymphatic glands were also enlarged, but to a 

 lesser degree. There was consolidation of the lower lobe of 

 the right lung, and the spleen was about twice its normal size. 

 In brief, the necropsy findings of a typical case of septicaemic 

 plague were present. Smears from the spleen and the right 

 axillary gland showed immense numbers of bipolar-staining 

 organisms. Cultures made from fresh pieces of tissues and 

 later inoculated into animals gave positive results for plague. 



ROUTINE RAT PRECAUTIONS PRIOR TO HUMAN OUTBREAK 



The city of Manila is divided into 5 sanitary divisions. Each 

 division is in charge of a medical officer, who has a corps of from 

 10 to 40 sanitary inspectors to assist him. During the entire six 

 years during which plague was absent, test rat catching was 

 done at weekly intervals under the direction of each station at 

 places that were believed to be liable to become rat-plague in- 

 fected, and in addition any unexplained mortality among rats 

 was always investigated, but at no time were plague rats found. 



HUMAN CASES 



In view of the. foregoing, it was with considerable surprise 

 that the first case of plague was found in a human being. This 

 case was discovered June 17, 1912, in a Filipino employed as a 

 watchman at 236 Calle San Jacinto, which is in the Chinese 

 district, his residence being at 920 Calle Antonio Rivera, which 

 is the slum section of the city. 



