7
house, where previously a plague case had occurred, and died in the evening. On
examining the corpse later, I found a femoral bubo had developed and all the
symptoms of the septic form of plague.
The signs of death from plague which may be looked for, are :—
1stly—The presence of a bubo which after death remains ; a favourite
trick of relatives was to place the body on the side of the bubo, or to leave
the head over in the case of a cervical bubo, or to place the arm tightly to
the side in an axillary one and allow the body thus to stiffen in order to
hide them.
2ndly—Hæmorrhages from the stomach, intestine or nose ; the presence
of petechiæ and extravasations of blood beneath the skin.
3rdly—Sordes on the lips and teeth ; and the state of the tongue, which
after rigor mortis has set in cannot be examined.
4thly—A rise or continuance of temperature above the normal after
death. In one marked case, of a woman who had been dead for 2½ hours
and who had a well-developed bubo, the temperature in the axilla registered
104.2° F.
5thly—The surroundings of the body should be carefully observed for
evidences of hæmorrhages, pneumonic sputa and other discharges.
6thly—Hypostasis or post mortem staining starts early and is generally
excessive ; also swelling of the features is of frequent occurrence.
To carry out this inspection efficiently, it is necessary to have a segregation
party ready to segregate, where it is necessary, in order to avoid the further
spread of the disease.
Type of the Disease in Poona.
I am inclined to believe that the type of the epidemic in Poona was not of
so virulent a nature as in Hongkong in 1894, although it was responsible for
a large number of deaths.
According to my own observations the chief type of the disease in Poona
was the bubonic, that is, those showing glandular enlargement. The glands
most aflected being either the oblique or vertical chain in the groin ; perhaps the
inguinal were more affected in women and the femoral in men. Enlargement
of other sets of glands, such as the axillary and cervical, were frequent also in
the parotid.
Three cases of double sets of glands being affected came under my notice,
two where the poplitial gland below the knee was affected and suppurated with
cusumy lymphangitis of the thigh extending to the femoral glands. The third
case where the gland at the elbow was primarily affected by a typical bubo with
rapid extension to the axillary glands of the same side.
It seems probable that these bubonic cases are much less dangerous in
point of contagion and can be approached with more or less safety, whereas the
septic type of the disease, namely, cases in which the bacillus is freely found in
the blood, is highly dangerous to those in the immediate vicinity.
At the commencement of the Poona epidemic, there was a fair proportion
of these septic cases, characterised by hæmorrhages from the stomach, lungs
and intestines, and a peculiar form of pneumonia, accompanied by diarrhœa,
meningitis, delirium and other nervous symptoms.
The petechial form of the disease, the one which led in former times to the
name of the " Black Death," was extremely rare. One case in the Mahomedan
hospital with what was termed " necrotic disease or ulceration " bore, I think
no relation to the disease, as this condition must have existed a long time pre-
vious to the attack of plague.
The septic form of the disease is very fatal, death coming about by the
sheer virulence of the bacillary poison or by consequent heart failure, pneu-
monic hæmorrhage, exhausting diarrhœa or meningitis.