7
to touch, and often the general cutaneous sensibility to pain also seemed
impaired, but in a few cases there was marked hyperœthesia.
intelligence was generally unaffected at firstiirst, but sometimes the patient
appeared to be dazed and stupid and totally indifferent to his surroundings.
Memory was defective, or he was unequal to making an effort of memory when
asked, for example, to give the date of attack, or to state what his symptoms had
been. In a number of cases, owing to inco-ordinatioo of the lingual muscles,
there was thickness of speech like that caused by alcoholic poisoning, and this
symptom was so characteristic that the attendants in hospital came to look
upon it as a certain sign of plague in cases where enlarged glands had not
already appeared. Later in the disease dumbness not infrequently occurred
from paralysis of the laryngeal muscles. In addition to loss of muscular powei
in the upper and lower limbs there was tremor and twitching of the muscles
of the hands, and in many cases marked loss of co-ordination also, causing
clumsiness of movement in the hands, and giving rise to a staggering gait on
attempting to walk. As a rule there was loss of expression, owing to relaxation
of the facial muscles, giving the patient an apathetic or a stupid look, and
masking the approach of death. Occasionally at the beginning of the illness
the expression was anxious. In a number of cases cerebral symptoms were
present from the commencement of the disease and continued day and night
throughout the attack, taking sometimes the form of delirium and at others that
of coma. The delirium was of the busy type, like that of delirium treniens,
and was often accompanied by illusions terrifying in character, from which the
patient tried to escape ; among children convulsions frequently took the place
of delirium. In cases marked by stupor the mental faculties appeared to be
paralysed, the patient lying in a comatose condition, from which he could only
be roused with difficulty, if at all. Such cases generally died within the first
two days, but sometimes even within 24 hours.
The respiratory symptoms were hurried breathing and a sense of oppres-
sion and tightness across the chest. In most cases congestion of the bases of
the lungs occurred early, and was rapidly followed in many instances, parti-
cularly during the cold months, by bronchitis, by oedema of the lungs, or by
secondary pneumonia. In these cases of secondary pneumonia the expectoration
was bronchitic in character, and after a short time became profuse and watery,
often showing a considerable colouring of blood. These blood-stained serous
sputa, owing to the patient's clothing becoming reddened by them, sometimes
gave rise to the impression that haemoptysis had occurred. Primary plague
pneumonia was also met with, but this form of plague (which was first re-
cognized and described by Surgeon-Captain Ohilde) during the present epidemic
is so important as to require a detailed description.
In connection with the digestive system, the occurrence or vomiting at the
onset of the disease, in some instances accompanied by diarrhoea, has been
referred to above. In some cases nausea, vomiting and diarrhoea appeared at
the onset and persisted throughout the whole course of the attack. The.
vomited matter was at first bilious in character ; afterwards it contained only
water and such liquid nourishment as had been taken. Diarrhoea when it
occurred was also bilious in character, the motions numbering five or six in
twenty-four hours, the stools being always very offensive and sometimes tinged
with blood. In a certain proportion of cases there was pain and tenderness in
the epigastric region, pain in the back, and abdominal distension, accompanied
by enlargement of the liver and spleen. Surgeon-Captain Hojel has recorded
a number of cases of this sort in which low nervous symptoms occurred like
those met with in enteric fever, and in some of these cases petechise were seen
on the abdomen and lower part of the thorax somewhat resembling the rash
of enteric. After death the lesions found were those of plague ; Peyer's patches
were found to be slightly raised, œdematous and congested, the solitary follicles
were as large as hempseed, but enlargement of the mesenteric glands was absent«
In the circulatory system there was throbbing of the carotids, and the
apex beat of the heart could generally be seen at the beginning of the attack.
The impulse at the apex was found to be more diffuse than normal, and some-
times a thrill could be felt in the precordial region. The sounds soon became