Cook)
to be rather those of
septicaemia."
CONTRACTED BY CUTS AT PLAGUE NECROPSIES. By C. It. M.
GREEN, F.R.C.S. (Eng.),
SURGN.-CAPTAIX, I.M.S., Police
Surgeon,
Calcutta.
The first of the cases here recorded is taken from notes kindly supplied by Dr. Nield Cook, the Health Officer of Calcutta. " In making the post mortem examination of the fatal case of plague which first drew public attention to the existence of that disease in Calcutta, and in which case undoubted plague bacilli were found, one of the domes who assist at the necropsies, Budri by name, scratched himself on a point of bone. On April 19th, or two days after the post mortem, his temperature rose to 102?Fah., pulse 105, with frontal headache and general malaise. That night his temperature was 103 6?Fah. His tongue was dry and coated, the eyes were congested and the skin dry and harsh. "On April 21st, although nothing was observed at the seat of inoculation, a swelling was discernable at the bend of the left elbow, but no gland could be distinctly made out owing to infiltration. That night his temperature was 105-4o. He was very ill at the time, but from then to May 1st, the temperature gradually came down to normal, and the patient was doing well; the arm which was swolleu and tense shewed signs of suppuration on April 28th and four ounces of pus were let out by incision. "On May 2nd,symptoms of pneumonia appeared and he coughed up frothy blood. He died on May 3rd, fourteenth day from the commencement of the attack. Medical opinion was divided over this case, some holding that it was a case of ordinary septicaemia,and others that it was plague septicaemia. Taking into consideration the fact that he had done a large proportion of the post mortem at the morgue for fifteen years, and had been known to have cut himself in the most purulent cases such as acute peritonitis and the like, without taking any precautions, and without experiencing an}^ bad effect, one came to the conclusion that he must be, to a considerable extent, immune to ca3cal infection. Moreover, the culture tubes inoculated from the cadaver from which he was infected gave pure plague cultures free from impurities. Besides the clinical features of the case appeared to me (Dr. Nield
than
ordinary
The case which came under my observation in another of the domes, named Sukhu, and aged 35 years. He assisted at the post mortem examination of a case of plague that died at the Campbell Hospital of Calcutta on June 3rd, 1898. This was an undoubted case of plague. On the morning of June 8th, I was informed that he was very ill. I found him in his quarters with a temperature of 103"5?Fah., heavy and stupid in his manner, eyes suffused and a dry tongue. There was an enlarged gland in the left axilla, the size of a small hen's egg, that He was was tender on pressure but movable. said to have had fever two days. He was removed to the isolation ward. On May 9th his temperature was 106, the pulse small and weak. The gland in the left axilla had increased greatly in size, and from inflammatory exudation it was He was unmore fixed and its limits obscured. conscious and could not be roused, but restless and tossing about so much, that, to prevent his falling off the bed, two beds were joined together He died and the patient placed in the middle. at 5-30 p.m. on May 10th. This man was at first stated to have cut his finger at the time of making the post mortem, and, on examination, there was a small nearly healed cut on the right thumb, but no wound or abrasion was found on the left upper extremity, although the axillary glands were affected on this side. In the case of Budri, the symptoms commenced two days after the post mortem, in Sukhu's three da}7s apparently, and in the case recorded by Surgeon-Captain Prall, two days after inoculation. I have reported the above cases as they may be of value in fixing the limits of the incubation period after inoculation by plague. With ordinary precautions and if the hands and forearms are kept wet with an antiseptic solution and sciatches guarded against, I do not think there is much danger to those engaged in these examinations. Domes are particularly careless in taking precautions, however much you may insist on their doing so. Cuts and abrasions, that they receive at post mortem examinations, heal quite kindly that would, in all probability, cause blood poisoning in a person not constantly employed in the dead-house. This immunity, which they have so long enjoyed, is the cause of their was
FURTHER CASES OF BUBONIC PLAGUE
plague
confidence.
to be rather those of
septicaemia."
CONTRACTED BY CUTS AT PLAGUE NECROPSIES. By C. It. M.
GREEN, F.R.C.S. (Eng.),
SURGN.-CAPTAIX, I.M.S., Police
Surgeon,
Calcutta.
The first of the cases here recorded is taken from notes kindly supplied by Dr. Nield Cook, the Health Officer of Calcutta. " In making the post mortem examination of the fatal case of plague which first drew public attention to the existence of that disease in Calcutta, and in which case undoubted plague bacilli were found, one of the domes who assist at the necropsies, Budri by name, scratched himself on a point of bone. On April 19th, or two days after the post mortem, his temperature rose to 102?Fah., pulse 105, with frontal headache and general malaise. That night his temperature was 103 6?Fah. His tongue was dry and coated, the eyes were congested and the skin dry and harsh. "On April 21st, although nothing was observed at the seat of inoculation, a swelling was discernable at the bend of the left elbow, but no gland could be distinctly made out owing to infiltration. That night his temperature was 105-4o. He was very ill at the time, but from then to May 1st, the temperature gradually came down to normal, and the patient was doing well; the arm which was swolleu and tense shewed signs of suppuration on April 28th and four ounces of pus were let out by incision. "On May 2nd,symptoms of pneumonia appeared and he coughed up frothy blood. He died on May 3rd, fourteenth day from the commencement of the attack. Medical opinion was divided over this case, some holding that it was a case of ordinary septicaemia,and others that it was plague septicaemia. Taking into consideration the fact that he had done a large proportion of the post mortem at the morgue for fifteen years, and had been known to have cut himself in the most purulent cases such as acute peritonitis and the like, without taking any precautions, and without experiencing an}^ bad effect, one came to the conclusion that he must be, to a considerable extent, immune to ca3cal infection. Moreover, the culture tubes inoculated from the cadaver from which he was infected gave pure plague cultures free from impurities. Besides the clinical features of the case appeared to me (Dr. Nield
than
ordinary
The case which came under my observation in another of the domes, named Sukhu, and aged 35 years. He assisted at the post mortem examination of a case of plague that died at the Campbell Hospital of Calcutta on June 3rd, 1898. This was an undoubted case of plague. On the morning of June 8th, I was informed that he was very ill. I found him in his quarters with a temperature of 103"5?Fah., heavy and stupid in his manner, eyes suffused and a dry tongue. There was an enlarged gland in the left axilla, the size of a small hen's egg, that He was was tender on pressure but movable. said to have had fever two days. He was removed to the isolation ward. On May 9th his temperature was 106, the pulse small and weak. The gland in the left axilla had increased greatly in size, and from inflammatory exudation it was He was unmore fixed and its limits obscured. conscious and could not be roused, but restless and tossing about so much, that, to prevent his falling off the bed, two beds were joined together He died and the patient placed in the middle. at 5-30 p.m. on May 10th. This man was at first stated to have cut his finger at the time of making the post mortem, and, on examination, there was a small nearly healed cut on the right thumb, but no wound or abrasion was found on the left upper extremity, although the axillary glands were affected on this side. In the case of Budri, the symptoms commenced two days after the post mortem, in Sukhu's three da}7s apparently, and in the case recorded by Surgeon-Captain Prall, two days after inoculation. I have reported the above cases as they may be of value in fixing the limits of the incubation period after inoculation by plague. With ordinary precautions and if the hands and forearms are kept wet with an antiseptic solution and sciatches guarded against, I do not think there is much danger to those engaged in these examinations. Domes are particularly careless in taking precautions, however much you may insist on their doing so. Cuts and abrasions, that they receive at post mortem examinations, heal quite kindly that would, in all probability, cause blood poisoning in a person not constantly employed in the dead-house. This immunity, which they have so long enjoyed, is the cause of their was
FURTHER CASES OF BUBONIC PLAGUE
plague
confidence.
