AN ISOLATED CASE OF PLAGUE 
♦ 
By A. STANLEY GRIFFITH, M.D. Vict. 
Alexander Fellow in Pathology 
This case, the leading features of which I shall briefly describe, shows the 
importance, and, from a public health point of view, the necessity of a systematic 
examination of all pathological material of doubtful nature derived from hospitals. 
The case was remarkable in that, although it was the first one of the recent small 
epidemic in Liverpool to be definitely proved to be plague, no connexion could be 
traced with cases that subsequently occurred, or with those which, by reference to 
death returns, were strongly suspicious of plague. The positive diagnosis was not 
made until the end of the tenth day, and this was mainly owing to the fact that the 
guinea pig inoculated with a piece of the enlarged gland did not die for nearly nine 
days, and it was felt that the chain of evidence was not complete without this additional 
link. The early microscopical and cultural appearances also were sufficient only to 
foster the suspicion of plague, for in the former case the film preparations showed 
very few organisms, whereas reference to text-books led one to expect that films made 
from a plague gland would resemble a pure culture, whilst in the latter case the rapid 
involution of the primary cultures, with the almost complete absence of regular forms 
at the end of forty-eight hours, prevented the expression of a positive opinion. 
The patient was a young man, aged 19, employed in a linseed oil mill. He was 
admitted to the Medical Wards of the Workhouse Infirmary on September 28, under 
the charge of Dr. Nevins. 
His illness began on September 26 with headache, vomiting, and ' strangeness 
in his manner.' 
On admission his temperature was 103 "2° ; there was a little delirium, photo- 
phobia, and irritability ; there was also in the left groin a small swelling, which the 
patient said was due to a kick received whilst playing football. On the second day 
his temperature rose to 104 0 , falling the morning after to 99- 5 0 . He continued in 
much the same condition, with almost constant delirium, until October 2, when it 
was decided by Dr. Alexander to cut down on the swelling. At the operation no 
pus was found, only some soft dark-coloured masses, which were removed. 
Dr. Alexander advised operation because he thought that the swelling in the groin 
might be due to an inflammatory process set up by the kick, and that the patient's 
general condition might be relieved by the free drainage of any septic material. 
