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JAMA 100 Years Ago |

Observations on Plague.

JAMA. 2002;288(2):143. doi:10.1001/jama.288.2.143.
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Terni remarks in regard to the diagnosis which presents considerable difficulty, especially during the initial outbreak. There is often a lack of positive clinical and pathologic features and as a result such diagnoses as lymphatitis, and malarial lymphatitis are made, with serious consequences. In every country in which plague has recently appeared mild cases have been reported, some of which end in spontaneous cure. The differential diagnosis between lymphatitis and bubonic plague is given in some detail. The initial lesions of plague are almost invariably bubonic and it is only when the disease has lasted some time and the bacilli have acquired a marked degree of virulence that gastro-intestinal, septicemic or pneumonic forms appear. The non-bubonic lymphatitis usually presents the symptoms of phlegmon with lymphatitis, adenitis, septicemia, and other symptoms, and bacterially, Streptococcus pyogenes, occasionally staphylococci and diplococci are found. These cases generally begin with some slight injury, while plague bubo is not preceded by any previous lesion. The characteristic features of plague are:

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