much corneal
injection,
partially conscious, could
V
/
/
(Pitjpi of 3jo8jital |ractii|c. THE CHAUSA CAMP PLAGUE CASE. By Stjbgn.-Capt. TV. J. Buchanan, b.a., m.b,, Medical
Officer
in
Charge.
Bhugwan Singh, cet. 30, was detained bj" the Inspecting Medical Officer, and admitted to the camp on February 23rd, 1898, having come from the infected area in Jullundar District. On inquiry, it appeared that his village was Clrarupur, and that on his way to Phagwara Railway station he halted one night at Malipatta, one of the known infected villages, to see his friends. At time of admission to camp he was in apparent good health and was seen by me daily. On Saturday evening he was seen by Assistant Surgeon Mukerjee and was then apparently well. Next morning (Sunday 27th) on going my round of the camp he was not present; on inquiry his friends said he was asleep. This not satisfying me I went into his hut and found him with high fever, 103?F. pulse, 126; respiration, 26; tongue, thickly coated ; constipation; no enlarged glands. No pneumonic or bronchitic symptoms. Evening temperature 103?F. He was at once removed to the Plague Hospital in another part of the camp with all the other Sikhs of his party. It was at once apparent that we had to deal with something more than an ordinary case of simple fever. In a few hours he became heavy, dull and apathetic, reminding me strongly of cases of typhus fever I had seen in the Cork Street Fever Hospital in Dublin.
February 28th.?Did
not sleep at night. Ts Fever weak. dropped at 7 a.m. to 998?F., very but soon rose to 101 6?, about which it remained all day. Patient is very dull and heavy looking,
he not
all
day only tongue, was was very strange
was
put
out
fed with great difficulty. Pulse (and this continued during the whole of the illness), at one time it was full and bounding about 112, soon after it would be found to be This was very 120 or loO, small and thready. frequently noticed. Bowels had not acted after calomel. Enema brought away scybala only. Towards evening a sudden acute painful swelling of left wrist appeared. March 1st.?Condition noted as very bad, very prostrate, mostly unconscious, lies on his back with eyeballs turned up and lids half closed, giving a characteristic staring look to the face. Much corneal injection. He lies in this state for some time, then begins restless movements of arms and legs; first draws up one leer, then extends it, then does the same with other leg, after repeating this and similar .movements of his arms he turns on his side, or tries to get out of bed. No pneumonia, no bronchitis, no buboes, pain in swollen wrist very severe, cannot put out tongue, teeth and lips covered with sordes. Tip of tongue when mouth is opened is seen to be bright red, also at edges. Change of pulse also noted today. Temperature kept from 10r6? to 102?F, Pulse over 126. March 3rd.?The spleen having been found somewhat enlarged, it was thought advisable to try at night a large dose of quinine (gr. 30\ Next morning (March 3rd) temperature 100? only; pulse, ] 20; respiration, 26. He appeared at 7 a.m. much brighter. But this condition was very transitory, in a few hours the temperature rose again to 102?F. about which it remained all day. More quinine was given, but without any effect. He soon relapsed into the semi-unconscious state, but was able to take some milk and brand}7, Tongue very dry and cracked on dorsum, tip and edges red. Herpes appeared on lips and chin, large separate vesicles. Seen by Dr. Dyson, the Sanitary Commissioner, Bengal, and blood taken from finger tips, which were pale and bloodless. Slides prepared and four agar tubes inoculated. Sent to M. Haffkine, Bombay. Slides stained with fuschin. Examined with T^th oil-immersion lens, several bacilli seeri, but I do not profess to be expert enough to say they were plague bacilli. Temperature 6 p.m., 102,6?F. Is very restless, now muttering delirium.
March 4th.?Was very restless and delirious all night. Temperature 6 a.m. was 3 Ol'G.0 Very weak. Pulse change, as before, noted to-daj'. Bright red tip of tongue. No buboes ; no pneumonia. Left wrist joint much swollen and painful, no other joint affected, albuminuria traces. Sp. gr. of urine, 1035. Remained very delirious all day, temperature at 6-30 p.m., 102'4?F. March 5th.? Unconsciousness and muttering delirium continued all night. Limbs and arms very tremulous ; tongue coated but red at tip, Pulse all day veiy small and very rapid, 130-140.
ASPIRATION OP LIVER: HATCH.
Apkil 1898.]
Respirations 102-4,
Temperature
7 A..M Does
much, lies on his back, restlessly rolling on one or
eveiv
from 30 to 40.
at 2 P.M. =102
not move limbs now
and then
side.
6,
at 6 P.M., 103?.
so
March dth.
without buboes, though very rarely. It will be seen from the above list of symptoms that, buboes apart, the clinical picture is that of plague ; all the above occur in plague, and all were present in this case, many of them of course are present in other severe fever cases in the so-called typhoid state." On the whole, if the case was not plague, I am at a loss to suggest a diagnosis, after plague it seemed to me to most resemble typhus, a disease which, 12 years ago, I saw a good deal of in Dublin. occur
,
othei
by Assistant-Surgeon breathing very rapid, over 6* pulse 150 ; temperature 103?. Noisy rattling in trachea and bronchial tubes, was given ruin anc water. Tiie Assistant-Surgeon left him to tetcn
Mukerjee
me, met
Seen
at 7 A.M.
me on
on
our
attempted back
arrival
we
his
to raise
suddenly
dead.
It was found impossible to obtain a- postmortem examination on account of objections of his father and friends, but an endeavour was made to obtain blood from the spleen through a small opening. Six tubes were inoculated, four sent to Mons. Haffkine and two kept by me. Of the tubes sent to Mons. Haffkine I have to-day (March 15th) received the report. Ivvo were sterile and two showed some growth which did not appear to be characteristic of plague. An examination of two slides sent to Dr. Neild Cook of Calcutta, was also uncertain, the bacilli seen did not appear t}7pical of plague, nor did they appear to be of any kind of septicaemia. In view of this negative evidence from bacteriology and from the absence of buboes, it is impossible to be certain that this was a case of plague. The clinical history pointed strongly to such a diagnosis, as well as the history of having spent a night in an infected village.
The
"
,
the road and
found the patient had head and had fallen ^ March 6th.)
following symptoms
were
clearly
?
noted
in this case and are characteristic ot plague (vide Dr. James' excellent clinical account in his report to the Punjab Government) : (I) Onset of the disease was so sudden (-) sudden change for the bad after a few houis illness; (3) turning round on side and restlessness; (4) injection of conjunctivae; (5) tired This weary look; (6) sudden changes of pulse. was specially noted ; ; (7) spleen enlarged " In some cases no bubo makes its appearance (James); (9) in a few hours patient became down worse ; (10) appearance of a man smitten with a fatal disease;" (11) sleeplessness, restlessness, moves arms and legs about, raises knees and straightens them out again, kicks ofi^ bed " clothes; (12) waking vigil," coma-vigil, limbs tremulous; (13) sudden and fatal collapse from heart failure, so often happening in plague cases ; (14) a slight drop in temperature on 2nd day ; (15) lumbar pain; (16) apathy soon set in; (17) drop of blood from finger exuded very slowly and was very watery ; (18) tongue was characteristic, white thick fur with bright red tip and edges; (19) urine acid, sp. gr. high ,
(8j
"
1036, albuminuria; (20) an acute swelling of the larger joints noted in some of Yersin's cases at Bombay ; (21) plague may =
of
some
13?
injection,
partially conscious, could
V
/
/
(Pitjpi of 3jo8jital |ractii|c. THE CHAUSA CAMP PLAGUE CASE. By Stjbgn.-Capt. TV. J. Buchanan, b.a., m.b,, Medical
Officer
in
Charge.
Bhugwan Singh, cet. 30, was detained bj" the Inspecting Medical Officer, and admitted to the camp on February 23rd, 1898, having come from the infected area in Jullundar District. On inquiry, it appeared that his village was Clrarupur, and that on his way to Phagwara Railway station he halted one night at Malipatta, one of the known infected villages, to see his friends. At time of admission to camp he was in apparent good health and was seen by me daily. On Saturday evening he was seen by Assistant Surgeon Mukerjee and was then apparently well. Next morning (Sunday 27th) on going my round of the camp he was not present; on inquiry his friends said he was asleep. This not satisfying me I went into his hut and found him with high fever, 103?F. pulse, 126; respiration, 26; tongue, thickly coated ; constipation; no enlarged glands. No pneumonic or bronchitic symptoms. Evening temperature 103?F. He was at once removed to the Plague Hospital in another part of the camp with all the other Sikhs of his party. It was at once apparent that we had to deal with something more than an ordinary case of simple fever. In a few hours he became heavy, dull and apathetic, reminding me strongly of cases of typhus fever I had seen in the Cork Street Fever Hospital in Dublin.
February 28th.?Did
not sleep at night. Ts Fever weak. dropped at 7 a.m. to 998?F., very but soon rose to 101 6?, about which it remained all day. Patient is very dull and heavy looking,
he not
all
day only tongue, was was very strange
was
put
out
fed with great difficulty. Pulse (and this continued during the whole of the illness), at one time it was full and bounding about 112, soon after it would be found to be This was very 120 or loO, small and thready. frequently noticed. Bowels had not acted after calomel. Enema brought away scybala only. Towards evening a sudden acute painful swelling of left wrist appeared. March 1st.?Condition noted as very bad, very prostrate, mostly unconscious, lies on his back with eyeballs turned up and lids half closed, giving a characteristic staring look to the face. Much corneal injection. He lies in this state for some time, then begins restless movements of arms and legs; first draws up one leer, then extends it, then does the same with other leg, after repeating this and similar .movements of his arms he turns on his side, or tries to get out of bed. No pneumonia, no bronchitis, no buboes, pain in swollen wrist very severe, cannot put out tongue, teeth and lips covered with sordes. Tip of tongue when mouth is opened is seen to be bright red, also at edges. Change of pulse also noted today. Temperature kept from 10r6? to 102?F, Pulse over 126. March 3rd.?The spleen having been found somewhat enlarged, it was thought advisable to try at night a large dose of quinine (gr. 30\ Next morning (March 3rd) temperature 100? only; pulse, ] 20; respiration, 26. He appeared at 7 a.m. much brighter. But this condition was very transitory, in a few hours the temperature rose again to 102?F. about which it remained all day. More quinine was given, but without any effect. He soon relapsed into the semi-unconscious state, but was able to take some milk and brand}7, Tongue very dry and cracked on dorsum, tip and edges red. Herpes appeared on lips and chin, large separate vesicles. Seen by Dr. Dyson, the Sanitary Commissioner, Bengal, and blood taken from finger tips, which were pale and bloodless. Slides prepared and four agar tubes inoculated. Sent to M. Haffkine, Bombay. Slides stained with fuschin. Examined with T^th oil-immersion lens, several bacilli seeri, but I do not profess to be expert enough to say they were plague bacilli. Temperature 6 p.m., 102,6?F. Is very restless, now muttering delirium.
March 4th.?Was very restless and delirious all night. Temperature 6 a.m. was 3 Ol'G.0 Very weak. Pulse change, as before, noted to-daj'. Bright red tip of tongue. No buboes ; no pneumonia. Left wrist joint much swollen and painful, no other joint affected, albuminuria traces. Sp. gr. of urine, 1035. Remained very delirious all day, temperature at 6-30 p.m., 102'4?F. March 5th.? Unconsciousness and muttering delirium continued all night. Limbs and arms very tremulous ; tongue coated but red at tip, Pulse all day veiy small and very rapid, 130-140.
ASPIRATION OP LIVER: HATCH.
Apkil 1898.]
Respirations 102-4,
Temperature
7 A..M Does
much, lies on his back, restlessly rolling on one or
eveiv
from 30 to 40.
at 2 P.M. =102
not move limbs now
and then
side.
6,
at 6 P.M., 103?.
so
March dth.
without buboes, though very rarely. It will be seen from the above list of symptoms that, buboes apart, the clinical picture is that of plague ; all the above occur in plague, and all were present in this case, many of them of course are present in other severe fever cases in the so-called typhoid state." On the whole, if the case was not plague, I am at a loss to suggest a diagnosis, after plague it seemed to me to most resemble typhus, a disease which, 12 years ago, I saw a good deal of in Dublin. occur
,
othei
by Assistant-Surgeon breathing very rapid, over 6* pulse 150 ; temperature 103?. Noisy rattling in trachea and bronchial tubes, was given ruin anc water. Tiie Assistant-Surgeon left him to tetcn
Mukerjee
me, met
Seen
at 7 A.M.
me on
on
our
attempted back
arrival
we
his
to raise
suddenly
dead.
It was found impossible to obtain a- postmortem examination on account of objections of his father and friends, but an endeavour was made to obtain blood from the spleen through a small opening. Six tubes were inoculated, four sent to Mons. Haffkine and two kept by me. Of the tubes sent to Mons. Haffkine I have to-day (March 15th) received the report. Ivvo were sterile and two showed some growth which did not appear to be characteristic of plague. An examination of two slides sent to Dr. Neild Cook of Calcutta, was also uncertain, the bacilli seen did not appear t}7pical of plague, nor did they appear to be of any kind of septicaemia. In view of this negative evidence from bacteriology and from the absence of buboes, it is impossible to be certain that this was a case of plague. The clinical history pointed strongly to such a diagnosis, as well as the history of having spent a night in an infected village.
The
"
,
the road and
found the patient had head and had fallen ^ March 6th.)
following symptoms
were
clearly
?
noted
in this case and are characteristic ot plague (vide Dr. James' excellent clinical account in his report to the Punjab Government) : (I) Onset of the disease was so sudden (-) sudden change for the bad after a few houis illness; (3) turning round on side and restlessness; (4) injection of conjunctivae; (5) tired This weary look; (6) sudden changes of pulse. was specially noted ; ; (7) spleen enlarged " In some cases no bubo makes its appearance (James); (9) in a few hours patient became down worse ; (10) appearance of a man smitten with a fatal disease;" (11) sleeplessness, restlessness, moves arms and legs about, raises knees and straightens them out again, kicks ofi^ bed " clothes; (12) waking vigil," coma-vigil, limbs tremulous; (13) sudden and fatal collapse from heart failure, so often happening in plague cases ; (14) a slight drop in temperature on 2nd day ; (15) lumbar pain; (16) apathy soon set in; (17) drop of blood from finger exuded very slowly and was very watery ; (18) tongue was characteristic, white thick fur with bright red tip and edges; (19) urine acid, sp. gr. high ,
(8j
"
1036, albuminuria; (20) an acute swelling of the larger joints noted in some of Yersin's cases at Bombay ; (21) plague may =
of
some
13?
