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. home either by his clothes or in his hair. Many similar examples could be cited and this brings out the I may add that the Liverpool outbreak did not occur in the fact that immunity to plague, like immunity to any of the slums of Liverpool but in a good-class locality and the only group of infectious diseases, depends on conditions, the other theory of its origin besides the Glasgow infection was exact nature of which we have yet to solve, for plague may that a policeman who lived with the mother and daughters evidently at one time be so harmless that we could play with who first sickened of plague might have been the carrier of it, while at other times it may be most virulent, dealing the infection, for he was employed at the mortuary at death all around. It is this fact that has no doubt led Princes Docks. Against this theory was the fact that there Simpson to write these weighty words, which should be was not even a shadow of a suspicion that the said police- pondered over by every physician and especially by those in man had handled a body of anyone who had died from the public health service : ’’ There is one feature of the present plague. pandemic of plague that presages danger in the future. It At the end of October, 1901, there was a recrudescence of is that notwithstanding its apparent inability to cause in one plague in Glasgow, four patients being found in the Central place a great epidemic it exhibits in some places marvellous Station Hotel, while other two in association with them powers of recrudescence and resistance to all known sickened of the same disease. These cases were well known measures of prevention, and this even when the cases are to the public and I believe that a connexion was traced few. This tenacious capacity, combined with its transport- between them and Mr. Murdoch’s cases. From then up till ability, makes it formidable because its slow progress, few August, 1907, I am not aware of any cases of plague cases, and possibly slight mortality accustom the people to occurring in Glasgow. During the past three months its presence and lull the authorities into a frame of mind of (August, September, and October) there has been another looking upon it as a disease that can be easily controlled. recrudescence of plague in the city. There is a difference In the meantime it gradually dots itself over different parts of opinion about the number of cases. The Health Depart- of the country, securing a firm hold in some localities which ment of the city only admit the existence of two cases, while again form fresh centres for its activity until in the course of in my opinion there have been nine cases, and of these five a few years it is firmly established in the country at many were children who died from septicsemic plague. In a sub- centres and only awaits the conditions necessary for its sequent issue of THE LANCET I shall publish full clinical development into an alarming epidemic." notes of these cases along with my reasons for con- Glasgow. _____ sidering them plague. This second recrudescence of plague simply confirms our modern experience of the disease, that when it attacks a community it has a tendency A NOTE ON THE MORPHOLOGY OF to and linger to recur in the said community. Another SPIROCHÆTA DUTTONI.1 important fact is that my cases in 1900 occurred in the latter half of Mr. Murdoch’s cases and case that August, my BY THE LATE J. EVERETT DUTTON, M.B. VICT., infected Liverpool occurred in the latter half of August, 1901, while the first case of the latest recrudescence occurred AND in the latter part of August, 1907, thus bearing out what JOHN L. TODD, M.D. MCGILL, Simpson has stated that plague recurs in the same locality ASSOCIATE PROFESSOR OF PARASITIC PROTOZOOLOGY, MCGILL at the same season of the year, and even in epidemics, UNIVERSITY. while sporadic cases may occur all the year around ; the (From the Expedition of the Liverpool School of Tropical wave of epidemicity reaches its height at a particular season Medicine in the Congo, 1903-04-05.) of the year for each particular locality. The practical value of this observation is to be specially on the alert for plague at the season of the year it first appeared in any BREINL (1),2 in the current number of the Annals of community. Tropical Medicine and Parasitology, describes the variations A few remarks on the infectivity of plague in Great in the morphology of Spirochaeta Duttoni observed during Britain in the light of our modern experience of it may not the experimental study of that parasite made at the Runcorn be out of place here. When the second outbreak of plague laboratories of the Liverpool School of Tropical Medi- took place in Glasgow in 1901 I wrote an article for the cine (2). His description is based upon the examination of Glasgow Herald on the infectivity of the disease so as to dried and fixed preparations of blood and of organ juices of allay the public mind. In that article I pointed out that in infected animals stained by Giemsa’s modification of the original outbreak in 1900 there was not the shadow of a Romanowsky’s method ; films fixed while still wet were not doubt that plague was in the city at least three weeks before found to show more detail. In his paper many new points its presence was suspected or even dreamt of. During that are brought forward and antecedent observations made by period a whole population of 800,000 were exposed to its others and by ourselves (3) are confirmed and completed. infection, yet the net result was only 36 cases. In the The first part of the present note is, with the exception of a Central Station Hotel outbreak the three servants were ill few additions, an abstract of Breinl’s paper. for several days before the disease was detected, and 200 Spirochæta Duttoni is ribbon-shaped on transverse section. employees and 300 guests were exposed to the infection, Though often wound in spirals it may be simply waved and yet the net result was six cases. In the Liverpool hence may lie wholly in one plane ; this can often be outbreak in 1901 the family with typical buboes were demonstrated in motionless parasites in fresh preparations. ill five weeks before detection and the whole city of 700,000 The spirccbasta consists of a central core which stains a deep inhabitants were exposed to infection, yet the net result was red and a surrounding periplastic sheath which stains a nine cases. In an outbreak in Leith in May, 1905, for an light pink (4). Both ends of the parasite are pointed, but official report of which I am indebted to Dr. W. Robertson, one end (rarely both), through an extension of this sheath, the four patients were ill for several days before the true is often prolonged into a flagellum-like process from which nature of the disease was diagnosed, yet the net result was the central core is absent. No suggestion of peritrichal only four cases confined to one family. flagella (8) has ever been seen (4). The central core, or I have observed some striking instances of immunity to chromatic part, of the parasite frequently does not stain plague. In one of my cases in 1900 a young woman was ill uniformly but shows more or less numerous irregularly- with plague for 18 days before I was asked to see her. placed, unstained areas occupying the whole breadth of the During that time her mother, who was 58 years of age, slept parasite (5, 6, 7). Sometimes, especially in preparations with the plague patient, ate the food that the plague patient taken just as the parasites are about to disappear from the was unable to eat and which was handled by the plague blood, this fragmentation proceeds until the whole chromatic patient, and for the whole 18 days there was the most core is broken up into irregular granules ; a clear area, of intimate contact between the mother and her plague-stricken daughter, for they occupied a single apartment, yet the 1 A paper read before the Society of Tropical Medicine and Hygiene mother never sickened of plague and died five years later on Nov. 15th, 1907. This note communicates the results of the last from a In the outbreak, of the studies on which Dr. Dutton was engaged at the time of his simple pneumonia. Liverpool death. In remembering his work all must admire the zeal which while the two were immune to direct girls evidently enabled him to accomplish so much that was good before he reached infection while in Glasgow and immune to the con- his thirtieth year; in remembering him we all regret his untimely they carried with them to the said death at an age when most men are first attaining their mature tagion Liverpool, yet for usefulness.-J. L. T. was able to infect their mother and she must then capacity contagion 2 The parenthetical figures throughout the text refer to the have developed a more virulent form of the disease, for it bibliography at the end.