PA THOLOG Y—DIA GNOSIS 



1963 



gradual; after perhaps two or three days of vague malaise and slight 

 fever, the patient complains of pain in one or both of the inguinal 

 regions, which increases on walking. On examining the parts, 

 one or more inguinal glands, or occasionally the crural glands on 

 both sides, or more frequently one side only, will be found to be 

 enlarged, very painful on pressure, and hard. The swelling may be 

 as large as a goose's egg. There will be no signs of lymphangitis 

 present. The glands may become greatly enlarged, reaching the 

 size of a hen's egg or larger, but in most cases do not suppurate. 

 Aspiration by means of a syringe will draw only a little gland- 

 juice, occasionally blood-stained, but no pus. The liquid will be 

 found to be sterile. 



Fever is often present of an irregularly remittent or inter- 

 mittent type. It rarely exceeds 102° F.; and is higher at night 

 than in the morning. The duration of the disease is variable, from 

 a few days to several weeks, and rarely months. In time the pain 

 in the affected region gradually disappears, the size of the enlarged 

 glands decreasing. As a rule, the affected glands remain larger 

 than normal, but not painful, long after the illness is over. Occa- 

 sionally a relapse occurs. The general health is not much affected, 

 though the patient may be very weak and unfit for work. The 

 spleen is not enlarged. The examination of the blood may reveal 

 a slight leucocytosis; Wassermann's reaction is negative; the urine is 

 normal. Occasionally a trace of albumen may be present. Intes- 

 tinal symptoms are generally absent. 



Clinical Varieties. — In our experience an acute, a subacute, and 

 a chronic type of climatic bubo may be distinguished. The acute 

 type is always accompanied by fever and severe pains in the 

 afected glands. All the symptoms disappear within five to ten 

 days. In the subacute and chronic type lasting from a few weeks 

 to several months the onset may be insidious, without any local 

 pain at first, and fever may be absent altogether. Moreover, in 

 some cases the periglandular tissues become inflamed, suppuration 

 may take place, and fistulous tracks may develop. 



Diagnosis. — The absence of soft chancre on the genital organs 

 will exclude venereal bubo ; the absence of lymphangitis, infected 

 wounds, insect-bites on the legs and feet will exclude the ordinary 

 symptomatic bubo. In contrast to plague, the patient does not look 

 very ill, but the only satisfactory way to differentiate acute climatic 

 bubo from a mild case of plague is the puncture of the affected glands 

 and the bacteriological examination of the gland-juice. To do this 

 the skin of the inguinal regions is thoroughly cleansed with spirit 

 and ether, then disinfected with a perchloride (i in 1,000) or carbolic 

 lotion (5 per cent.), then washed again with ether or spirit, or more 

 simply the skin may be painted with tincture of iodine. One of the 

 enlarged glands is then aspirated with a sterilized sjnringe. The 

 gland- juice which is drawn off is then examined microscopically 

 and by culture method in the ordinary way for the presence of the 

 plague bacillus. 



