9
generally fell by lysis on the fifth, sixth and seventh days. But not infre-
quently a fall by crisis occurred on one of these days (vide Charts II. VIII.
XXII.) and the patient remained in a more or less collapsed condition with
subnormal temperature, profuse perspiration and an exceedingly feeble pulse
for days. In this condition the slightest effort sometimes gave rise to fatal
syncope. In the Parel Hospital 22 convalescents, out of 304 cases treated there
by Surgeon-Captain Thompson, dropped dead through attempting to get out oï
bed or to sit up.
When the patient was recovering, it was occasionally found that he was
suffering from dumbness or from partial laryngeal paralysis ; or that hemiplegia,
paraplegia involving the legs or the legs and arms, monoplegia of a limb or a
portion of a limb was present. In some cases facial paralysis was observed, or
paralysis of one or more ocular muscles. More rarely the inco-ordination of
the tongue, hands, arms or legs, noticed at the beginning of the attack, remained
present during convalescence, and the speech continued slow, thick, and indistinct
(vide the case of Kalliau Vishram given below).
Occasionally an attack of plague ran a very mild course, the patient
(frequently a boy of 10 or 12 years) not being confined to bed by it. In these
cases enlargement and tenderness of a lymphatic gland was noticed, followed
by fever (vide Chart XXVI), headache, a characteristic tongue and sometimes
nausea and vomiting; the temperature rarely exceeded 103° F. or 104° F.,
and generally fell to normal or subnormal on second or third day. Prostration
and cerebral symptoms were not well marked, and the bubo subsided as a rule
without suppurating. The duration of the attack seldom exceeded three or four
days, and convalescence was established in a week or ten days.
There remain to be described two forms of the disease in which the general
features of plague in its most acute form were present, but in which there was
no particular enlargement of lymphatic glands (buboes) during life, and in which,
after death, only very slight general enlargement and congestion of the glands
were found.
In one of these forms of plague the microbe grows in the blood, hence it
has been called septiccemic plague ; in the other it grows in the lungs giving
rise to primary plague pneumonia.
In septiccemic plaque the invasion was usually marked by a prolonged
and severe rigor, or repeated rigors ; and vomiting, headache and high fever
were constantly present. The most distinctive features of this form of the
disease were the great nervous prostration and muscular weakness present from
the beginning, and the rapidity with which cerebral symptoms supervened.
Delirium often set in during the first day, and was quickly followed by picking
at the bed clothes, stupor and coma, in which the patient died generally on the
second or third day, but sometimes within 24 hours of the onset. In some cases
death did not occur for several days. The pulse early became soft and very
frequent, 120 to 140 or more, the temperature (vide Chart XXV.) rapidly rose
to 104° F. 105° F. 106° F. ran an irregular course and often reached 107° F. or
more before death ; respiration was hurried and panting ; gastro-intestinal
catarrh and tympanitis were frequently present; the urine was often retained.
Epistaxis and sub-conjuuctival heemorrhage sometimes occurred ; blood was
occasionally seen in the stools and uriue ; and, it the patient lived long enough,
secondary pneumonia sometimes sot in. These cases were very fatal.
In a considerable number of cases primary plague pneumonia was observed,
the development of the disease being due to the growth of plague bacilli in
the lung tissue. Lobular pneumonia was the form usually met with in these
cases. Its onset was marked by rigors, or, in some instances, by chills,
followed by a sense of constriction across the chest, difficult and hurried breath-
ing, cough and expectoration. As the disease progressed, respiration became
very frequent (40 to 60 in the minute) and difficult, and duskiness of the face
appeared. Pain was present, but never appeared to be severe or stitch-like in
character, and was rarely much complained of. The expectoration, bronchitic
at the beginning, very soon became watery and profuse ; it often contained little
B 1751—3