Report on the outbreak of the plague at Sydney, 1900 / by the Chief Medical Officer of the Government and President of the Board of Health.

  • Thompson, J. Ashburton (John Ashburton), 1848-1915.
Date:
1900
Catalogue details

Licence: In copyright

Credit: Report on the outbreak of the plague at Sydney, 1900 / by the Chief Medical Officer of the Government and President of the Board of Health. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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    e fatty as well in thirteen; tliis appeared to be a recent change. In two, minute whitish points distributed throughout its substance betokened necrosis; in three cases it was cirrhosed from old standing disease. The cortex of the kidneys was swollen and pale in twelve cases, and occasionally was speckled with pin-point haemorrhages. In Case 8i the former condition was ascertained to be due to catarrhal nephiitis at an early stage. The lungs were the seat of old-standing disease in three instances, in five others they were congested, in three others engorged with Ijlood, and in eight others there was a moderate oedema; in one case lobular pneu- monia was noted. Bacteriologiccd Evidence.—Once the presence of plague in epidemic form has been recognised, a large majority of cases can be quite certainly diagnosed by clinical methods alone; and this is fortunate, because rigid bacteriological proof of the nature of this disease can seldom be had before the fifth day from beginning to seek it. Nevertheless, not merely at the beginning, but during the course of every epidemic, bacteriological proof is occasionally demanded. At t]ie beginning it is essential, in view of the consequences v\'hich at present follow on the announcement that an indigenous case of plague has arisen among the inliabitants of a large city or an important seaport. So momentous an opinion should not be given but on absolute proof that the disease is plague, and the proof remains incomplete until it has been supported by a bacteriological demonstration. In the course of an epidemic it is also occasionally required in cases of doubt; for accuracy of diagnosis is a first condition of successful management. But in this case the same rigid proof is not necessary as in the former, and a microscopical examination of the juice of an enlarged gland, or (in few and fatal cases) of the blood, will furnish all the corroboration needed to establish a diagnosis already highly probable on clinical grounds. Bacteriological demonstration of tlie nature of the disease already described, consisted briefly in detection in the juice of buboes, and in some other tissues, secre- tions, or excretions of the diseased body, of a micro-organism which had the folloAving morphological, cultural, and pathological characteristics, and a definite reaction to certain stains. The organism was usually present in enormous numbers in smears made from enlarged glands, or from viscera. Tlie individual elements Avere segre- gated, though not infrequently two were seen end to end, as though they had been produced by recent fission : they stained with aqueous solutions of fuchsin, methyl IjIuc, and gentian violet, and did not retain the stain when treated by Gram's method. In stained preparations it presented a matured form, which was either that of a typical bacillus, or else it was whetstone or boat shaped ; interspersed among these were rounded, oval, or dumb-bell shapes resembling micrococci or diplococci. The greatest mixture of forms was observed in smears from tissues, but there was ahvays a preponderance of the mature forms. The bacillary form had an average measurement of l8/u,, and a breadth of 'S/x,; the latter showed little variation, the extreme measurements of length were and 2''f/x.. The rounded forms had a diameter between'o/x and l*0/x. The poles of the bacillary form Mere often more deeply stained than the centre; in some preparations, practically every bacillus showed more or less deeply stained ends, and a central portion which remained clear and unstained, and which varied in width between a small space and the greater part of the body of the bacillus between the ends. In other preparations only a few elements showed this bi-polar staining, and occasionally it was not at all evident. Cultivation on dry or salted agar produced crops of involution forms ; some elements became greatly enlarged, so as to measure 5 /x. or 0 /x. in length by 1 ^. in breadth, Avithout losing the shape or staining proi)erties just described; others became otherAviso altered, and formed sausage, pear, spindle, circular, or oval shaped bodies, having no resemblance to the bacilli from AAdiich they Avere deriAxd. On nutrient agar, inoculated from buboes or viscera and incubated at 37° C, the first noticeable growth appeared in the form of minute bright specks in from thirty-six to forty-eight hours. In a day or two these colonies become colourless hemispheres from 5 to 1*0 mm. in diameter; some of them then enlarged slowly to a diameter of 2 to 3 mm., became flattened, and cloudy toAvards the centre. The maximum d(;velopment was reaclunl in two Aveeks. Individual colonies avim'(> hard to pick uj), slipping about under the needle; fuscnl colonies Avere often tenacious, and could be pulled out in stiiiigs. In sub-culture tlie growth appeared earlier than in the original, and developed as a confluent .streak, raised and cloudv along the middle,
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