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Appendix II.
CLINICAL REPORT ON THE OUTBREAK OF PLAGUE, IN 1903, AT FREMANTLE.
The outbreak was confined to eight persons. The first case was diagnosed on January 26th, and the last on February 26th; the last patient was discharged on March 24th.
Sex.—6 males; 2 females.
| Age.— | Between | 10 | and | 20 | years | 3 | cases. |
| ” | 20 | 30 | ” | 4 | ” | ||
| ” | 50 | 60 | ” | 1 | case. |
Mortality.—4 of the 8 patients died, giving a mortality of 50 per cent.
Mortality in previous outbreaks:—
| 1900 | ... | 6 | cases | ... | 3 | deaths | 50 | per cent. |
| 1901 | ... | 23 | ” | ... | 5 | ” | 21 | ” |
| 1902 | ... | 3 | ” | ... | 3 | ” | 100 | ” |
| 1903 | ... | 8 | ” | ... | 4 | ” | 50 | ” |
The average period in hospital of those who recovered was 37 days.
Mode and Source of Infection.—This is merely a matter of conjecture. All that can be said is that the patient lived or worked in places where or near which infected rats were found; but how the infection was transmitted from the rat to the human being cannot be stated. The first three cases showed many flea bites; and all stated that the premises were infested with vermin. Four of the cases lived and worked in infected areas; the other four worked there only. The rat infection is dealt with in the general report, but a reference to the accompanying map will show the relationship between the location of infected rats and the occurrence of cases of plague.
Form of Plague.—All the cases were attended with the formation of buboes—bubonic type of plague.
In six cases the femoral region (three on right side and three on left side), in one case axilla, and in the other the inguinal region were the sites of the bubo. In two cases the buboes were multiple—in one case, right axilla and supra-clavicular region, and in the other in left femoral and right cervical region. Suppuration occurred in two of the four cases that recovered; and the plague bacillus was demonstrated in the pus in each case.
In seven cases the bubo was easily felt when patient was first seen, and, according to patients' statements, developed in from 24 to 36 hours after onset of illness. In one case the development of the bubo could be watched, and this took 36 hours to reach its full
