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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![Group C. As in the previous groups, the sume premonitory symptoms were recorded. Forty-nine cases com- plained of vomiting, and 14 died ; 49 also complained of headache, of them 10 died. Pains in the back, etc., were complained of only 13 times, with 3 deaths ; rigors occurred in 62 cases, with 14 deaths. Symptoms referable to the glandular system are noted in 34 cases, with 5 deaths. Even when allowance is made for the fact that in this group only 93 cases are under consideration as against 100 in the two previous groups, it would appear that the number of persons complaining of pains in the back and bones had very markedly decreased. The mean average of the first noted temperatures was found to be 102-1. Buboes.-—The inguino-femoral chain in this group produced 58 of the total of 89 cases in which buboes were found, the remaining 31 being divided thus : Axillary and subpectoral regions furnished 16, cervical 4, and the cervico-axillary region combined with some other region, or with each other, furnished 11. There were 4 cases without any buboes, which brings the total up to 93. The mortality as shown in Table 4 points to the same preponderance in the same regions as was noticed in the other groups, the axillary and subpectoral chain being most fatal, with 50 per cent. ; the cervical being the next in order, wdth 25 per cent., until the inguino-femoral chain is reached with 12 per cent. Thirty buboes were incised. Of these 30 incised cases 1 died, and 43 recovered without incision, the buboes resolving. Thus 40 per cent, of the cases recovering needed operation. There were 20 deaths iri which no incision was justified. The percentage of cases recovering with resolution was 59-7. Nervous Symptoms.—Symptoms referable to derangements of the nervous system : Coma occurred in 3 cases, with 3 deaths; semi-coma (not going into coma) in 3 cases, with 2 deaths ; delirium (ordinary) in 18 cases, with 7 deaths; delirium (furious) in 6 cases, with 3 deaths ; getting out of bed in 7 cases, with 2 deaths; hebetude is noted once, with no deaths ; affection of speech in 12 cases, with 2 deaths ; insomnia in 3 cases, with 2 deaths; loud screaming in 3 cases, with 1 death ; convulsions in 1 case, with 1 death; staggering gait in 2 cases, with 2 deaths. One or more of the foregoing occurred either singly or in combination with each other in 39 cases, or in 42 per cent, of the total admissions. Of these 39 there died 16, being 41 per cent, of deaths. Spitting was observed in 1 case, which was fatal. Organs of Vision.—The conjunctiviE were deeply injected in 5 cases with following result:—That in 1 case there was some iritis going on to hypopyon, wdiich cleared up the eye, recovering finally, though very weak. Of the other 4 cases, 1 died too early in his illness to show what the future held in store for his eyes, while the remaining 3 never became more than merely conjunctiva injection ; finally they cleared up altogether. Eruptions of the skin in this group were : Eczema, once ; urticaria, several times ; erythema, once; petechia, once ] large ecchymosed patches came out in 1 case a short time before death. Septiccemic Cases.—There were 4 cases in which no glandular symptoms were distinguishable during life. Of these, 2 were admitted to hospital, and 2 were overcome before it was possible to remove them. Of the 2 who were removed to hospital, 1 recovered ; the other, after an illness of 9 days, died. Group D. This group comprises the cases inoculated with Haffkine's prophylactic. They are placed in Table 2 to show how their premonitory symptoms compare with those of the cases in Table 1, where the whole list of cases in each group is dealt with. It is worthy of note that on comparing these two tables it appears that the inoculated cases had milder prodromal symptoms. These persons suflered from vomiting as an initial symptom only 4 times out of the 13, and from pains in the back and body only once. Their glandular regions were aflected as follows :— Swelling of the right femoral occurred 4 times, of them 1 was incised; left femoral 4 times, of them 3 were incised; right inguinal once it was incised; left inguinal twice, 1 was incised ; right inguinal and femoral once it was incised; right and left femoral once, and was not incised ; right cervical once, and was not incised. Thus of these 14 buboes, 7 were incised, the remainder resolved. As strengthening this comparison, it is to be borne in mind that Table 1 has the advantage of having the inoculated cases included in it, so that it gets the benefit of their less-marked symptoms. Group E. Chinese.—There is not much to be said of this group, because of the 10 persons who were attacked 7 were discovered in extremis. Those whose faculties were not completely clouded by the intoxication of their disease were unable to speak English well, and could not give much information. Two out of 10 recovered, and of them 1 suffered the loss of an eye as a result of the injection of the conjunctivje followed by iritis and panophthalmitis. Both eyes were afiected with iritis, but in the 1 case it cleared away, and good vision has remained in this eye, while total loss of vision resulted in the other. The buboes recorded were 1 right inguinal, 1 right inguinal and femoral, 1 right and left inguinal, 1 left axillai-y, 1 left cervical, 1 right and left cervical, 1 right femoral. Three had no buboes, as far as can be ascertained. That case with the right inguinal and femoral gland affected, and that case with the right femoral affected, are the 2 which recovered. In both cases the buboes were incised. In 1 of the Chinese a carbuncle formed on the right hip. He recovered. Of the 10 who were attacked, 5 were admitted to hospital, the other 5 died before they could be removed. Of the 5 admitted to hospital, 2 recovered, the remainder died. Taking all the cases together, reference must be made to a symptom exhibited by a few cases, and not referred to in the detailed account, viz., swelling of the legs, especially of the thigh. The swelling was not edematous. No glands were perceptible to the touch, and there was no tenderness in any of the glandular regions. This occurred only occasionally during the acute febrile stage of the disease, and in some cases death supervened, in others recovery. That swollen condition frequently seen during and after convalescence is not the swelling now referred to. This last was fairly frequent, and was doubtless caused by the impediment to the return circulation resulting from a healing bubo. The first took place when there had been no apparent bubo. Haemorrhages.—Those hajmorrhagic effusions occurring under the skin in cases of bubonic plague have been dealt with in the various groups under the heading of eruptions of the skin. Under the present heading the symptom referred to is an unnatural discharge of blood, suflacient in quantity either to threaten the life of the patient, or being poured into some important organ to cause the destruction of that organ. Althou<>h](https://iiif.wellcomecollection.org/image/b21354704_0066.jp2/full/800%2C/0/default.jpg)
