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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 "Septicæmic" Plague;
forms of the malady which may be taken 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 infectuous 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 "ambulant" 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 who, having been possibly exposed to Plague, exhibit these
symptoms, should be isolated and watched medically until the nature of their
malady has been definitely ascertained.
Bacteriological Diagnosis.
The Medical Officer of the Local Government Board, by a circular of the
same date, gives the following directions for obtaining and forwarding for
bacterioscopic examination material from a suspected case of Plague :—
(a) From the living person :
1.—Clean with soap and water and then with alcohol the last phalanx of
either the second or third finger. When dry, or after mopping
with a clean cloth, put a piece of tape round the proximal end of the
last phalanx, so as to cause venous congestion. Prick the palmar
surface of this phalanx with a sterile needle, and immediately take
up the exuding blood in two sterile capillary tubes such as are used
for collecting vaccine lymph. These tubes when charged should be
sealed at both ends.
2.—When there is a discharging buboe, collect fluid therefrom in
capillary tubes as in the case of blood. When this discharge is not
of a sufficiently fluid character for collection in this way place some
of it in a small glass-stoppered phial, previously well washed out
with alcohol, care being taken that no alcohol remains in the phial.
3.—If expectoration be obtainable, collect some in a phial in the manner
prescribed in Section 2.
(b) From the dead body :
1.—Cut out any inflamed lymph gland, together with some of its
surrounding tissue, and place the whole in a wide-mouthed glassstoppered
bottle, previously well washed out with alcohol, care being
taken that no alcohol remains in the bottle. The bottle should have
the stopper well secured and sealed.