1962 DISEASES OF THE LYMPHATIC SYSTEM 



and subtropical region. Le Dantec quotes cases occurring in 

 Mauritius, Tonkin, and Madagascar. Low and Castellani have 

 described a case in Uganda, while Luzzatti has met with several 

 cases in Chili. We have observed cases in Ceylon, and Skinner 

 has described numerous cases in Bengal. Climatic bubo may also 

 occur in the Temperate Zone, for Scheube has come across several 

 cases in Japan, Gabbi in Sicily, and Rost in other Mediterranean 

 districts. 



etiology. — Though various micro-organisms have been described, 

 the aetiology of the disease is still obscure. 



Ferraro, from one of his cases, isolated an organism practically identical 

 with Bacillus pestis. Hewlett isolated from the affected gland a bacillus not 

 decolourized by Gram, the characters of which were somewhat similar to those 

 given by Kitasato in his first description of B. pestis ; for Kitasato stated at 

 first that the B. pestis was not decolourized by Gram, Low and Castellani 

 were not able to grow any organism from their case. Some authors have 

 isolated the ordinary pyogenic cocci. 



Martin, Suger, Le Sueur, and Fleurant consider climatic bubo to be a 

 manifestation of malaria. Schimm believes the bubo to be secondary to some 

 intestinal infection. G, Rost believes the affection to be of sexual origin, 

 and due to a micro-organism living in the vaginal mucosa of native women. 



According to Cantlie, climatic bubo is a form of attenuated plague — Pestis 

 minor — basing this opinion on the fact that in Hong Kong he observed several 

 cases of so-called climatic bubo to precede the outbreak of an epidemic of 

 true plague. He has been confirmed in his opinion by Hewlett's discover 

 mentioned above. Cantlie's theory is supported by Luzzatti, who considers 

 the climatic bubo to be a form of Parapestis. Ernest Black suggests that the 

 disease may be due to an insect bite. 



Letulle and Nattan-Larrier have seen in the cells of the capillaries minute 

 bodies which they believe to be parasitic. 



In our opinion, climatic bubo is a disease per se, and is not 

 related to plague. 



Predisposing Causes. — The condition is apparently most commonly 

 met with in sailors and stokers. It occurs chiefly in young adults, 

 and is said never to be found in children. 



Pathology. — -The results of our histological researches agree 

 better with those obtained by Vanzetti in Italy on the material 

 collected in South America by Luzzatti than with those of other 

 authors. 



The capsule of the affected gland is much thickened, and the 

 interstitial tissue is very abundant. There is great proliferation of 

 lymphocytes, and haemorrhagic foci are noticeable here and there. 

 Very characteristic is the presence of numerous typical plasma cells, 

 while the so-called retractile Recklinghausen cells found in plague 

 are absent. The histological structure of climatic bubo is, therefore, 

 totally different from that of the plague bubo, in which, as was 

 shown by the classical histological investigation of Duerck, plasma 

 cells are absent or extremely rare, while the so-called retractile 

 ReckHnghausen cells are numerous. 



Symptomatology. — The length of the incubation is not known, 

 but according to some observers it may be prolonged. Ley and Rost 

 believe that it can extend to many weeks. The onset is generally 



