London's Pulse: Medical Officer of Health reports 1848-1972

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Clerkenwell 1900

Report on the public health and sanitary condition of the Parish of Clerkenwell [West Division, Borough of Finsbury] for the year 1900

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56
Parasites, such as fleas, bugs, lice, etc., acquire the bacillus from feeding on
plague sick persons, or they may gather it from clothing, bedding, etc., soiled by
excretions. It is probable that the bacillus gains entrance to the body most
commonly by the skin.
Signs and Symplons of Plague—
An ordinary attack of Plague usually begins some three to five days after
exposure to infection. Such an attack may develop gradually, but, as commonly
met with, there is sudden onset with much fever, as indicated by a high temperature,
rapid pulse, headache, hot skin, and thirst. The eyes are injected as if
inflamed; the expression, at first anxious and frightened, becomes subsequently
vacant and dull; the utterance is thick, and the gait unsteady as in one under
the influence of drink. There is at times a distinct tendency to faint. The
tongue is at first covered with a moist white fur, except at the edges, which are
red, but later on it becomes dry and of a mahogany colour.
Physical strength suddenly declines. Mental aberration develops rapidly.
The temperature may rise from 101° F at the onset to 103°-105°-l07o F during
the first few days, or it may reach 105° F within a few hours after invasion.
Sleeplessness is a distressing symptom.
The most distinctive sign of Plague is the presence of swellings, or "buboes"
as they are called, in the groin, armpit, or neck. These "buboes," which led to
the disease being called "bubonic plague" and which have no relation to venereal
complaints, appear as a rule about the second or third day of the disease. They
are large, smooth, elastic, bun-shaped swellings of the glands, usually painful and
tender on pressure, and in size they vary from that of an almond to that of an
orange. Later on they may "gather" and burst like an ordinary abscess.
There may also appear about the body purple spots, and what are known as
"carbuncles."
But buboes are not an essential feature of plague. Cases occur in which these
manifestations of the disease are greatly delayed or even absent, as for instance
in "Pneumonic," "Gastric," and "Septicaemic" plague—forms of the malady
which may be mistaken for respectively inflammation of the lungs, typhoid fever,
and acute blood poisoning. Plague in these forms is always grave; not only
because of the fatality of the cases, but for the reason that they, especially the
"Pneumonic," are highly infectious to other persons. It is important, therefore,
that in localities where Plague is present or is threatened, cases of anomalous
illness of the above sorts be without loss of time brought under medical
supervision.
Besides the forms of Plague already referred to there is yet another, namely,
the so-called "ambulent" form. In Plague of this description the affected
person is hardly ill at all, presenting no definite symptoms perhaps beyond
indolent, though painful, swellings in groin or armpit. Such Plague cases may
nevertheless be instrumental in spreading the disease, and any persons therefore


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