I430 



PLAGUE 



typhosus in the blood of typhoid patients is useful also for the search of the 

 plague bacillus, as proved by Kolle and others: lo c.c. of blood are collected, 

 under aseptic precautions, with a sterile syringe from a vein, and immediately 

 distributed into several flasks of slightly alkaline broth, each containing 

 300 cubic centimetres of the medium. In this way the bactericidal substances 

 of the blood are greatly diluted, and the growth of the plague bacillus facilitated. 

 Agglutination tests are not of much use in the diagnosis of plague. 



In places far from bacteriological laboratories Broquet recommends that a 

 gland or a portion of a gland obtained as soon after death as possible should 

 be placed in a vial containing 125 to 175 c.c. of a mixture of neutral glycerine 

 (30° B.) 20 c.c, distilled water 80 c.c, and carbonate of lime 2 grammes. 

 The mouth of the vial or flask is flamed and sealed with paraffin. On arrival 

 at the laboratory the glycerine is wiped off the gland, which is made into an 

 emulsion with normal saline, and injected, half into a guinea-pig and half 

 into a rat. It is stated that by this method virulence is maintained for 

 thirteen days, which is of great importance in the tropics. A dead animal 

 should be immersed in a solution of strong disinfectant, such as carbolic 5 per 

 cent,, in order to kill the fleas, and should then be placed in sawdust or other 

 packing in a hermetically sealed air-tight metal case, and forwarded for 

 examination, if the distance is not too far, to the laborator^r. 



Prognosis. — Simpson quotes Procopius of Caesarea as saying, 

 with regard to the plague in Byzantium, that many whose death 

 the physicians predicted recovered, while those who were supposed 

 to be about to recover often quickly died, from which it may be 

 inferred that the prognosis in cases of plague has to be most guarded, 

 for dangers are numerous even in convalescence — e.g., cardiac 

 failure. 



The prognosis varies with the character of the epidemic, some 

 being milder than others, and is better when the number of cases 

 is declining. It also varies for the type of the disease, being best 

 for the ambulatory and worst for the pneumonic. As 75 per cent, 

 of the deaths occur before the sixth day, after that time the prognosis 

 improves. 



A good pulse, a clear mind, a normal quantity of chlorides and 

 no albumen in the urine, are good signs. High fever, rapid, thready 

 pulse, violent delirium, sudden fall in the temperature, disappear- 

 ance of the buboes on the fourth or fifth day, and anuria, are bad 

 signs. But in all cases be cautious about the prognosis, and re- 

 member the physicians of Byzantium. In pneumonic plague the 

 prognosis is most unfavourable — e.g., in the Manchurian epidemic 

 of pneumonic plague no case in which the bacteriological diagnosis 

 was positive was known to recover. 



Treatment. — ^The treatment should aim at killing the bacillus 

 and neutralizing its toxins, and naturally one hopes to find those 

 requirements supplied by sera. Unfortunately no such serum has 

 as yet been found, though encouraging reports have been recorded 

 by Choksy and Polverini concerning Yersin's and Lustig's sera, and 

 by others concerning Cru7,'s serum. Whatever the serum, it should 

 be given in large doses (30 to 50 c.c, and even more) by subcu- 

 taneous injection. A second and a third injection can be given 

 during the course of the disease, but one should keep in mind the 

 possibility of anaphylactic symptoms in people previously in- 



