8
Most of the cases I examined with inguinal or femoral bubo had no enlarged
glands caused by old standing diseases, such as syphilis. It is a point worthy
of inquiry whether old standing inflammation of the lymphatic glands such as
syphilis would lead to the bubonic or septic type of plague.
Syphilis and plague may be concomitant, that is, a man with syphilis
may also be attacked by plague ; also it seems possible that small-pox and plague
may co-exist.
Nervous complaints very commonly followed cases convalescent from plague.
Insanity, general paralysis, also local paralysis, were observed.
Local paralysis was chiefly confined to a certain group of muscles such as the
laryngeal causing aphonia or else attacked the palatial, sometimes also the lingual.
One interesting case occurred in the Mahomedan hospital, which showed well-
marked aphasia. A girl aged 25 was admitted with high fever 104° F. to 105° F.,
femoral bubo and much frontal headache. Four days after the fever had abated
and seven days after admission to hospital, she suddenly lost speech, being unable
at first to form any words. Her intellect remained fairly clear, but her memory
was defective, but she indicated she understood what was said to her. On
careful examination there seemed to be no paralysis of any muscles of phonation,
palatial or laryngeal ; ultimately her speech returned, but remained of a
hesitating type. In another case, hamiplegic in type, a man, whoso attack of
plague was accompanied by much vomiting and high fever, on fall of tempera-
ture suddenly lost power of speech. Here the tongue and uvula were deviated
to the right and the reflexes were exaggerated. He gradually regained power
of speech, but his words were husky, indistinct, hesitating, with difficulty in
phonation.
He was constantly frowning and remained for various periods in an
apathetic state, but understood fairly well what was said to him.
Spastic paralysis was observed, but the former history was doubtful.
Hysteria certainly was developed, but this was probably consequent upon
the great weakness and depression, which is felt during convalescence and in
many cases was due to the want of judicious administration of stimulants.
A large proportion of cases die of heart failure, and it is of importance to
note that this heart failure is not one of cardiac degeneration ; on post mortem
examination we find little or no fatty degeneration or infiltration of the cardiac
muscular fibre, and there is rarely any marked increase in size. In one case of
a child who ultimately died, there was marked dilation of the right side of the
heart, but there was also pleurisy present.
The heart failure seems to be one of central origin, and indeed this is quite
compatible with the marked nervous symptoms which accompany the disease ;
and which point to plague being a disease of septic intoxication with poisoning of
all the cerebral centres, the result of the bacillary action.
Luckily in Poona the European population was singularly exempt from the
disease ; but it is possible that the conditions under which Europeans live in
Poona is accountable to a large extent for their freedom.
There is comparatively little or no contact with native surroundings, with
the exception of servants' quarters attached to bungalows where, indeed, some
cases did occur. Where every attention is paid to cleanliness and sanitation, there
is little risk to Europeans, when not brought into actual contact with the disease.
Of the three Europeans attacked, one was a medical man employed on plague
duty, the other a reporter of a newspaper, whose duty required his attendance in
the city when the plague was raging. Both were bubonic and both luckily
having mild attacks recovered. The third was a visitor from Bombay.
Pregnant women invariably aborted with death of the fœtus which was
followed in all cases by death of the mother.
Segregation.
The value of this measure in all epidemics of infectious disease is very evi-
dent, but in the outbreak of plague in Poona these measures were probably