10
whitish specks floating in it, and ou examination was found to contain plague
bacilli in great numbers. Frequently this serous expectoration was tinged of a
pink or reddish colour from the presence of blood; but rusty sputa, as in
ordinary croupems pneumonia, were rarely seen. There was great prostration
from the first ; the pulse soon became feeble and very frequent, so that the?
alteration in the pulse-respiration ratio ordinarily met with in pneumonia was
not observed; the temperature was high and ran an irregular course (vide
Charts XI, XII, XVII, XIX, XXIX,XXX, XXXI,); the tongue was coated white,
except at the tip and edges, and the bowels were confined. The physical signs
present were those of broncho-pneumonia, patches of consolidation being found in
one or both lungs, the right generally being the one most affected. Very soon
marked oedema occurred, the lungs becoming loaded with fluid. Buboes were
not met with in these cases, but slight enlargement of the lymphatic glands was
sometimes found before death. Death generally ensued in three or four days,
and was preceded by incessant cough and by blueness of the skin due to deficient
teration of blood, caused mainly by the amount of fluid in the air vesicles.
The complications met with in plague were — in the nervous system
delusions, in one case ending in insanity ; motor paralysis, local or general ;
impaired sense of touch ; sometimes diminished sensibility to pain, sometimes
hyperaesthesia ; deafness; ulceration of the cornea, conjunctivitis, and sub-
conjunctival haemorrhage. In the circulatory system, softening of the muscular
tissue of the heart with enfeebled cardiac action and dilation of the heart. In
the respiratory system, bronchitis; hypostatic congestion and oedema of the
lungs, secondary pneumonia ; pleurisy ; and rarely pulmonary haemorrhage.
In the digestive system gastro-enteric catarrh; diarrhoea; and in a few cases
haemorrhage from the bowels. In the urinary system, albuminuria ; renal con-
gestion, and renal hoemorrhage, in one case causing death. In the reproductive
system, menorrhagia at the menstrual period ; and abortion in many cases of
pregnancy. In the cutaneous system, sloughing of the skin, and boils.
The sequeléhe most frequently met with were deafness in one or both ears ;
impairment of vision due to degeneration of the choroid and retina: dumbness
due to the loss of memory of words, or to laryngeal paralysis ; paralysis of
the muscles of the eyes or face; paresis or paralysis of the muscles of the
extremities either hemiplegie or paraplegic ; inco-ordination of the muscles of the
face, tongue and extremities (vide case given below) ; impairment of cutaneous
sensibility to pain.
The duration of the disease in 902 fatal cases admitted into hospital was
19 hours in one case, one day in 5, two in 43, three in 9.9, four in 143, five in
129, six in 85, seven in 76, eight in 56, nine in 42, and ten in 24 cases. It must
be remembered that probably very few of the cases dying during the first 24
hours were brought to hospital, and that many of the cases dying on the second
and third day were also not detected and sent to hospital. The average dura-
tion of the disease from attack to death in 17 fatal cases among native prisoners
in the House of Correction, Byculla, was 5½ days.
Second attacks from plague occurred in two cases which have been re-
corded. In the first case the patient who had suffered from plague at Hong
kong in June 1894 was attacked in Bombay on the 6th December 1896, had
rigors, vomiting, high fever (105 F.), severe headache, and a bubo in the 'right
groin. The fever and other symptoms subsided within a week and she
recovered. The second case was that of a cooly admitted into the Arthur "Road
Hospital in November 1896 for plague. Pie was discharged cured in December
and continued to work until February 1897, when he was readmitted for
plague and died.
The diagnosis of plague in its most typical form is easy. The sudden
onset, rapid rise in temperature, vomiting, headache, sleeplessness, the stupid
expression, injection of the eyes, thick speech and great prostration point to
piague; and later, the condition of the tongue, the frequent and very feeble
pulse, the enlarged and painful lymphatic glands, the course of the temperature
showing a marked fall on the second or third day followed by a further fall to