Report on the outbreak of plague at Sydney [1900-1907] / by J. Ashburton Thompson, Chief Medical Officer of the Government and President of the Board of Health.
- New South Wales. Department of Public Health
- Date:
- 1900-1908
Licence: In copyright
Credit: Report on the outbreak of plague at Sydney [1900-1907] / by J. Ashburton Thompson, Chief Medical Officer of the Government and President of the Board of Health. Source: Wellcome Collection.
Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.
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![temperature often became subnormal, usually about the ninth clay ; it sometimes fell below 97° P., and continued subnormal for from one to three days. Su2:)puration now proceeded rapidly in the bubo, and was usually accompanied by some slight rise of the evening temperature; the abscess was most commonly opened on the tbirteenth day. In a less, but considerable proportion of favourable cases, the inflamed gland began to diminish in size, and gradually disappeared by resorption, but this jDrocess occupied several, or even many, weeks. The length of the period of conva- lescence was very irregular; usually it was estfiblished thoroughly by the third week, when debility and some discharge from the bubo alone remained. The wound, how- • ever, was rarely severe enough to prevent the patient from taking as much exercise as in other respects he was fit for, though occasionally extensile undermining of the skin long delayed his discliarge. If from the foregoing description of the average course of illness in uncom- plicated cases, which terminated either in recovery or death, we turn to consideration of individual cases, it appears that the disease exhibited itself in every degree of severity—tliat is to say, from a slight attack of fever which necessitated confiuement to bed for two or three days at most, accompanied by such swelling of a single gland as was a cause rather of discomfort than of pain, to an ill-defined attack of malaise on which death supervened after a few hours—or more often to an apparently moderate illness, which ended with unexpected death in about forty-eight hours from attack. Of the first degree. Case 1 (Appendix L, p. 77) was a good example, while the follow- ing are among those which represent the second and third. Case 2i0, m., cet. 45.— It was noticed that the patient's appetite fell off a day or two before attack, but this was not unusual with him, and ho made no complaint; he attended to his clerical duties as usual during the morning of May 19th, but at midday was obliged to leave by a fit of colic; he died at 10 p.m. Case 255, m., cet. 55.—The patient rose at G a.m. and performed his duties as ostler in the usual way, and without having been heard to complain, until 8 a.m. ; made a good breakfast, Avashed and dressed, and sat by the kitchen fire ; at 9'30 a.m. he was found dead. Both of these men were intemperate; but this was not so with Case 212, m., (vt. 17.—The patient rose at 8 o'clock, and complained of slight headache and nausea ; he went out, and at 10 a.m. was sj)okeu with by a policeman who afterA\'ards reported that he made no complaint, and did not appear to be ill ; at 2'-15 p.m. his breathing became laboured, and at 9*1'5 p.m. he died. The two folioAving patients died unex- l^ectedly, though not so abruptly. Case 14<2, m., cct. 5.—During April 22nd became feverish and vomited several times ; during the next thirty-six hours continued feverish, was sleepy or dull, and a tender swelling appeared in the right groin. He died quietly, but suddenly, at about the fifty-first hour of illness, without manifesting any other symptom. Case 81, m., cet. 3.—Woke at 3 a.m. on April Stli, feverish, thirsty, and with some slight muscular twitching. Vomiting set in, and continued till midday of April 6th. During the afternoon seemed much better, and played almost as usual. At 6 a.m. on April 7tli muscular twitching again appeared; he was sleepy or indifferent, and feverish, and he died suddenly about the fifty-first hour of illness. Fobt-mortcm Appearances.—These v/ere observed in twenty-four cases (Appendix D, p. G4), among which the five last referred to above were included. Erom this set of notes it aj)pears that petechi;c of the skin were noted in ten cases; petechiae of serous membranes, visceral and parietal, or of the mucous coat of the stomach and intestines, in nineteen. They were usually of the size of a pin's head or a little larger, but sometimes as large as a threepenny-piece ; and haemorrhages, or liLemoglobin staining, in the areolar tissue around internal organs were sometimes noticed, apart from enlarged lymphatic ganglions. The spleen was usually enlarged, rounded, softened, and dark in colour on section; it was noticed that tlie trabeculae were obscured in six cases; and in only two was this organ reported to ])e firm and in other respects of normal appearance. Inflamed, swollen, and sometimes necrotic lymphatic glands were noted in twenty-one cases, while in three none vrere found. They were surrounded with extravasated blood in fourteen cases, and in a less number of the latter there was also oedema of tlie surrounding areolar tissues. Buboes (sixteen) were—femoral, eight; inguinab four ; axillary, one ; and cervical, three. The heart, which often contained soft, pale-yellow gelatinous clots, showed paleness and softening of the myocardium in four cases, The liver was enlarged in fourteen cases, and was](https://iiif.wellcomecollection.org/image/b21354704_0011.jp2/full/800%2C/0/default.jpg)
