Difficulty. She Died at 4 in the Morning. As Was Done the Previous Year In

1522 livid, and the lips were blue, and she swallowed with nothing definite could be made out. The only diagnosis that difficulty. She died at 4 in the morning. I could make at the time was an acute ovaritis or some Necropsy.-There was slight thickening of the mitral obscure uterine affection. In reviewing that diagnosis in the valve. Peyer’s patches were injected but the intestines were light of Mr. Murdoch’s cases the following most suggestive otherwise quite normal. The brain was normal. facts are to be noted. 1. An isolated case of plague occurring Welbeck-street, W. in a city which is supposed to be free from plague would never suggest plague when no apparent buboes are present. It is the association of two or more cases that puts the IS BUBONIC PLAGUE STILL LURKING medical man on the alert. 2. This case occurred in Adelphi-street, about 100 yards from Thistle-street, and in IN THE CITY OF GLASGOW? the plague-infected area of the previous year. 3. It occurred about the same time as Mr. Murdoch’s cases in the BY THOMAS COLVIN, M.D.GLASG., latter part of August. 4. Acute ovaritis according to LATE PHYSICIAN TO THE GLASGOW VICTORIA INFIRMARY DISPENSARY ; Galabin and other writers is a very rare affection, and as a LATE PHYSICIAN TO THE GLASGOW CENTRAL DISPENSARY. rule follows septic mischief after delivery or abortion or gonorrhoea. My patient had not the slightest evidence of of these three conditions. she was the IN August, 1900, the inhabitants of Glasgow were startled any Moreover, very by the announcement that plague had appeared in their midst antithesis of those neurotics who often complain of ovarian for she never had a illness unless after an absence of 235 years from the shores of the British pain, day’s before, during nor has she ever been ill since and is at Isles. The first detected cases were three patients whom I confinement, present sent into Belvidere, the city for infectious diseases, in excellent health. 5. Simpson states that the chain of hospital and in the abdominal be from 57, Thistle-street, on the south side of the river Clyde, glands lymphatics cavity may affected and form a iliac bubo which is tender to with a provisional diagnosis of an acute infectious malady painful If on the side the condition be mistaken simulating enteric fever. These cases were ultimately proven pressure. right may to be bacteriologically, and for acute appendicitis. The iliac bubo may occur without clinically, pathologically, experi- of the The mentally bubonic In all 36 cases were traced and of any apparent enlargement inguinal glands. plague. of this the clinical and the these 16 died, which gave a mortality of 44 ’ 4 per cent. The previous history case, symptoms, all to an iliac bubo and not to acute last was from Belvidere on Nov. after-history point patient discharged 3rd, 1900, ovaritis. and ten days later Glasgow was declared free from plague. Now it was the week that was ill The of the outbreak was never discovered and the rats during my patient that origin her two friends from three with her. which infested the area where the disease appeared were on Liverpool stayed days examination found free from plague. Although they did not occupy the same bedroom, for there were five apartments in the house, they were in most intimate A year later, in August, 1901, two cases, which were no contact with the On 21st, or about four weeks doubt occurred in the area of the patient. Sept. plague, plague-infected their mother sickened and died from after an For a’ clinical note of these cases I am later, plague previous year. illness of seven with buboes in her axillæ. On indebted to Mr. Robert Murdoch. He states that on days 22nd one of the sickened and died from he was called to see a 12 Sept. girls plague August 23rd, 1901, boy, aged years, nine later with buboes. On 24th the in who was with a febrile tem- days axillary Sept. Crown-street, extremely ill, other sickened with with a bubo in her and and a in his No wounds girl plague groin perature, painful swelling groin. she recovered. A woman who assisted in out the or abrasions of kind were seen on the to laying any boy’s leg mother’s also died from while four children account for the bubo. Two later the father took body plague, days boy’s in an house sickened with three of ill with the of an acute living adjoining plague, suddenly symptoms pneumonia only whom died. Now as the mother was never in and with this characteristic difference-that instead of the usual Glasgow she was the first to sicken the infection was and of he at intervals indirect, rusty sputum simple pneumonia coughed up direct infection was also excluded the date of blood. He died after two illness. Mr. by sickening, pure suddenly days’ for the maximum incubation of is ten of consulted Dr. John average period plague Murdoch, becoming suspicious plague, But the mother the and Stewart and both were of that the had days. superintended washing laying gentlemen opinion boy aside of the clothes worn in and thus the bubonic and that the father had died from Glasgow caught plague pneumonic and a virulent form of Dr. A. K. the medical officer of infection, having evidently developed plague. Chalmers, health, the disease her two was at once communicated with and the and the dead infected daughters. boy In of the of the I elicited of his father were removed to Belvidere. proof contagiousness clothing body Every a most fact. Between the of these one who was known to be in contact with these cases was important sickening three cases and the of the four children nearly removed to the sanitary reception house, and the man’s sickening a month had elapsed, so here again the infection was house and his rag-store, where the infection was to presumed indirect. But the very week that two of these children have been caught, were disinfected in the same manner sickened their mother was wearing a blouse that had as was done the previous year in plague cases. been given to her by one of the girls who had been It was a knowledge of these two cases which I only learnt to Glasgow, for the girl’s mother being dead and the from Dr. Stewart months after their incidentally many blouse being of a bright colour she could not wear it herself, occurrence that me the to the solution of the gave key origin for she was in mourning. The last time this blouse was of an outbreak of in that two plague Liverpool happened worn by the girl was in Glasgow when in immediate contact months or in 1901. At the time I was later, October, deeply with her friend, who was ill presumably with plague, for the interested in this for I was asked Dr. Chalmers outbreak, by blouse was never worn by her after she sickened with plague a an illness of a of in to give him report of patient mine, on account of her mother’s death. I made strict inquiries ladies had for three whose house two Liverpool stayed days whether the blouse had been washed or cleaned before being and on their return home sickened with one of them plague, worn by the mother of the children and received a from I have studied dying that disease. carefully every negative reply, for the blouse was silk and a new one and known fact connected with this the outbreak, including only worn in Glasgow. I am indebted to E. W. official report for which Dr. Hope Cantlie relates that plague in 1900 was introduced into of and also with the Liverpool, including correspondence Durban from Mauritius in a way similar to what I have who is still in who young lady, Liverpool, unconsciously described. A family of six came from a plague-infected carried the infection from Glasgow into that city, and I part in Mauritius into Durban. Two months after their now submit evidence that is that the strongly presumptive arrival one of their sons opened a deal box which con- contagion was conveyed from the one place to the other by tained some soiled linen that the family had brought with infected clothing. them which had not been previously opened and the lad died On August 15th, 1901, I was called to see a young woman two days later from bubonic plague. Simpson also relates who had an indefinite illness. She had nausea and vomiting, many cases of clothing being a carrier of plague and many a febrile temperature, and extreme prostration, but the only of the cases of plague in China were traced to the practice definite symptom was an acute pain in the left iliac region. of the Chinese wearing the clothes of those who had died Even to this day she is certain of the site of the pain, for from that disease. One of the cases in the Glasgow out- among other remedies tried to soothe the pain was a fly- break in 1900 was the wife of a man who was employed in blister applied over its region. She had no buboes nor did Belvidere in disinfecting and removing clothes from plague she complain of pain in her axillas or in her groins. There houses. As this woman lived fully a mile from the plague- was no vaginal discharge and on bimanual examination infected area and had no association with any known plague 1523 cases her husband must have carried the infection into their infected both girls and caused the death of one of them.

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