?CHAP. II.]	its causes and characteristics.	17
Difficulties in
diagnosing the
disease
experienced in
Bombay.
In the report prepared by Mr. Snow, the Municipal Commissioner
of the City of Bombay, the following remarks are made with regard
to the difficulty experienced in diagnosing plague:
"The difficulty of accurately diagnosing this multiform disease is
admittedly very great; many suspicious cases were put down as
diphtheria; the resemblance to enteric often made the differential
diagnosis exceedingly difficult in the absence of bacteriological
examination; and even bacteriological examination not infrequently
proved abortive in clear cases of the plague. The disease in its
more infectious type was generally pneumonic and devoid of
glandular enlargements, or was wont to take the form of high fever
with slight cough. Doctors often differed in their opinions about
cases, and no clearer illustration of the difficulties of diagnosis can
be given than the fact that at the latest stages of the epidemic
numbers of cases had to be segregated-and that by medical officers-
not because the patients had plague, but because they had suspicious
symptoms."
Dr. McCabe Dallas, who was in charge of the Grant Road Plague
Hospital in Bombay, stated that during the early months of the
epidemic the pulmonary form of the disease escaped detection and
thus spread the infection unchecked. Dr. Bitter also noticed the
difficulty of diagnosing pneumonic cases by clinical symptoms.
Cases diagnosed
as plague which
are really
unconnected
with that
disease.
The experience of the City of Bombay illustrates how plague may
escape detection at the beginning of an epidemic. On the other hand,
when the alarm of plague has been raised, cases are often diagnosed as
plague which are really unconnected with that disease. On a number
of occasions reports were made to the Government of India of the
occurrence of plague cases in different parts of India which subse-
quently were found not to be true cases of plague.
Instance from
Calcutta.
The most important instance occurred in the city of Calcutta.
Early in October 1896, that is to say, shortly after the existence of
plague in Bombay had been ascertained, the occurrence of ten cases
in Calcutta and one in Howrah affirmed to be plague was reported
by medical officers to the Special Medical Board appointed by the
Government of Bengal. Considerable alarm was experienced, but
after sifting the evidence the Medical Board were able to report*
that these eleven cases were not true cases of plague, but simple cases
of enlarged glands, fever, bronchitis, and venereal disease. They
stated that looking only to the clinical symptoms they had no hesita-
tion in expressing their emphatic opinion that none of the cases could
properly be described as cases of bubonic plague.
* Appendix I.
3