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Bubonic plague with generalised eruption
405
BUBONIC
PLAGUE
WITH
GENERALISED
ERUPTION.
BY
E. J. CRAWFORD, M.B., CH.B., DzT.M. Medical Officer, HTestAfrican Medical Service, Nigeria.
In continuation 'of the Note recently published in these TRANSACTIONS by Dr. J. BALFOURKIRK,~ the following particulars of a somewhat similar case may be of interest. Ashabole, a Yoruba female, aged about 25 years, was admitted to Ogere Hospital on 20th September, 1925. Her relatives stated that she had been ill for two days before admission. O n admission she was extremely dazed a n d apparently in a dying condition, with a temperature of 104° F., a n d pulse of 128. Examination was negative except for the presence in the left axilla of a bubo, about the size of a small marble, and exquisitely tender. An intravenous injection of 10 per cent. mercurochrome (10 c.e.) was given one hour after admission. Later in the day she passed several small stools of almost pure blood. On the 21st September, in the morning, a slight papular rash was noticed on the dorsum of the feet and hands. Towards evening a similar rash developed in the right pectoral region, with a few spots on the back and face. By this time the papules on the feet and hands, which had been the first to appear, were the size of a pea, while those of more recent appearance varied in size from a pinhead to a split pea. The older papules had become vesicular by the 22nd, and contained a sero-purulent fluid. A few were confluent. Papules and vesicles were present in large numbers in the right pectoral and scapular regions, on the dorsum of the feet and hands, where there were three or four per square inch, and scantily on the abdomen, back and face. By this time the patient was quite unconscious ; she died in the early evening. P o s t - m o r t e m E x a m i n a t f o n . - - S e c t i o n of the bubo, now the size of a walnut, revealed the typical h~emorrhagic appearance of a plague bubo. Smears from it showed the presence of large numbers of organisms which exhibited bi-polar staining with thionin blue. In smears from the vesicles a similar organism Was found, this time almost in pure culture ; on section the papules were found intensely injected. * Trans. Roy. Soc. Trop. Med. and Hyg. (1925), xix, 84.
A~06
BUBONIC PLAGUE W I T H GENERALISED E R U P T I O N .
Lack of media and transport difficulties prevented more accurate cultural investigation. However, as this ease occurred during the height of a plague epidemic, in an area where smallpox and chicken pox were rare, I think that one is justified in assuming that, as the smears from the vesicles contained organisms morphologically identical with Bacillus pestis, the eruption was directly due to the plague. As it was, this was fairly generalised and obviously spreading at the patient's death. No macular rash was seen prior to the development of the papular eruption, but since the patient was an extremely dark negress, a slight macular eruption could easily have escaped observation. The skin, apart from the actual rash, showed no obvious change. The nature of the case confirms the relatives' statement, that the patient had been ill for t w J d a y s only before admission. The small size of the bubo, the extreme prostration, and the high temperature were typical of the worst type of bubonic plague- that which approximates to the frankly septicaemic type. The fulminating character of the attack, the absence of extensive reaction in the bubo, and the consequent speedy invasion of the body by B. pestis, probably accounted in this case for the skin eruption and its early appearance. I am indebted to the Director of Medical and Saifitary Services, Nigeria, for permission to publish this note.
BUBONIC
PLAGUE
WITH
GENERALISED
ERUPTION.
BY
E. J. CRAWFORD, M.B., CH.B., DzT.M. Medical Officer, HTestAfrican Medical Service, Nigeria.
In continuation 'of the Note recently published in these TRANSACTIONS by Dr. J. BALFOURKIRK,~ the following particulars of a somewhat similar case may be of interest. Ashabole, a Yoruba female, aged about 25 years, was admitted to Ogere Hospital on 20th September, 1925. Her relatives stated that she had been ill for two days before admission. O n admission she was extremely dazed a n d apparently in a dying condition, with a temperature of 104° F., a n d pulse of 128. Examination was negative except for the presence in the left axilla of a bubo, about the size of a small marble, and exquisitely tender. An intravenous injection of 10 per cent. mercurochrome (10 c.e.) was given one hour after admission. Later in the day she passed several small stools of almost pure blood. On the 21st September, in the morning, a slight papular rash was noticed on the dorsum of the feet and hands. Towards evening a similar rash developed in the right pectoral region, with a few spots on the back and face. By this time the papules on the feet and hands, which had been the first to appear, were the size of a pea, while those of more recent appearance varied in size from a pinhead to a split pea. The older papules had become vesicular by the 22nd, and contained a sero-purulent fluid. A few were confluent. Papules and vesicles were present in large numbers in the right pectoral and scapular regions, on the dorsum of the feet and hands, where there were three or four per square inch, and scantily on the abdomen, back and face. By this time the patient was quite unconscious ; she died in the early evening. P o s t - m o r t e m E x a m i n a t f o n . - - S e c t i o n of the bubo, now the size of a walnut, revealed the typical h~emorrhagic appearance of a plague bubo. Smears from it showed the presence of large numbers of organisms which exhibited bi-polar staining with thionin blue. In smears from the vesicles a similar organism Was found, this time almost in pure culture ; on section the papules were found intensely injected. * Trans. Roy. Soc. Trop. Med. and Hyg. (1925), xix, 84.
A~06
BUBONIC PLAGUE W I T H GENERALISED E R U P T I O N .
Lack of media and transport difficulties prevented more accurate cultural investigation. However, as this ease occurred during the height of a plague epidemic, in an area where smallpox and chicken pox were rare, I think that one is justified in assuming that, as the smears from the vesicles contained organisms morphologically identical with Bacillus pestis, the eruption was directly due to the plague. As it was, this was fairly generalised and obviously spreading at the patient's death. No macular rash was seen prior to the development of the papular eruption, but since the patient was an extremely dark negress, a slight macular eruption could easily have escaped observation. The skin, apart from the actual rash, showed no obvious change. The nature of the case confirms the relatives' statement, that the patient had been ill for t w J d a y s only before admission. The small size of the bubo, the extreme prostration, and the high temperature were typical of the worst type of bubonic plague- that which approximates to the frankly septicaemic type. The fulminating character of the attack, the absence of extensive reaction in the bubo, and the consequent speedy invasion of the body by B. pestis, probably accounted in this case for the skin eruption and its early appearance. I am indebted to the Director of Medical and Saifitary Services, Nigeria, for permission to publish this note.