Some practical aspects of the plague at Sydney / by Frank Tidswell.

  • Tidswell, Frank.
Date:
[1900?]
Catalogue details

Licence: In copyright

Credit: Some practical aspects of the plague at Sydney / by Frank Tidswell. Source: Wellcome Collection.

    8/52 (page 550)
    appear amongst us. But so far as tlie recognition of the disease was concerned, we had to depend on the mental [)icture we could form by perusal and analysis of available descriptions: for none of us had had any ])ractical acquaintance with plague, nor was there in our medical community any gentleman so equipped to whom we could look for aid. It thus came about that, for my own part, I awaited the expected crisis with all the doubts incidental to untested conceptions. As a matter of fact the first case was a perfectly clear and straightforward one, and thus fortunately was recognised without difficulty. But our subsequent experience was to the effect tliat whilst the majoi’ity of our cases were equally easy of diagnosis, we would now and then meet with one concerning which we could express no decided opinion on the clinical evidence presented. Speaking generally, one may say that giv'en a case exhibiting symptoms common to several acute febrile diseases, the only clinical manifestation that obviously invests it with the specific character of plague is the existence of a bubo. In the absence of this indication one can rarely be more than suspicious that the case is plague; the final adjudication, if forthcoming at all, is expressed by the bacteriologist, or only delivered at the post- mortem table. Ilence it appeared to me that the points of most practical importance in the recognition of plague were associated with (a) the characters of buboes, (b) the indications other than buboes which should induce a suspicion of plague, and (c) the means of obtaining a bacteriological examination. I have therefore selected these three matters for consideration in this part of my paper. Buboes.—I am unable to state from memory the exact pro- portion of bubonic cases in our epidemic, but that type of the disease was exhibited by the gi’eat majority of our patients. We had one or perhaps two pneumonic, and the rest were septicmmic. But I may here observe that although the same type was usually preseiA'^ed throughout the illness, this was not always the case. Bubonic patients commonly became septicmmic and showed bacilli in the blood, and sometimes there was a secondary pneumonia, with bacilli in the sputum. Such mutations cannot be predicted, nor can they always be detected. I call attention to them in this place merely as'an indication that it is not wise to attach a too rigid interpretation to the terms used in classi- fying the cases in an epidemic. Our experience was not altogether in accordance with the statement that buboes usually appear on the third day of illness. We generally found them present on the second, and in many cases on the first day, whilst in a few instances they were amongst the very earliest symptoms noticed by the patient.