8
feeble, the first sound being very much shortened, and the second sound so weak
that it frequently could not be heard at the apex. In one case only, out of a
very large number examined, was a murmur present, although in many cases
the heart appeared to be dilated. On examining the blood drawn from the
finger it was found to coagulate slowly, and the red corpuscles did not tend to
run into rouleaux quickly. In cases where the disease had lasted for a few
days the number of white corpuscles present was greatly in excess of the
normal. In most cases after the first day, and in all cases after two or three
days a marked fall in blood pressure occurred; this fall in blood pressure and the
great frequency of the heart's action were the most marked circulatory changes
observed.
In the urinary system pain was sometimes present in the region of the
kidneys. The urine secreted was diminished in quantity, of high specific gravity,
and intensely acid in reaction. In colour it was generally brownish yellow, but
sometimes it was smoky or red from the presence of blood. Albumen was
present in about three-fourths of the cases, urea and uric acid were deficient,
and chlorides markedly deficient ; casts were generally present. The attached table
(Table IX) gives a quantitative urine analysis made by Surg.-Capt. Hojel. It
shows the results obtained in fifty plague cases treated at St. George's Hospital.
With the exception of No. 19, all the analyses were made between the third and
sixth day ; all were examined as soon after admission as possible, and the majority
for several days in succession. Micturition was frequent in many cases, but
no symptoms of scalding were as a rule complained of. In cases which termi-
nated fatally the urine was often retained towards the end,
Where pregnancy was present, the patient, as a rule, aborted on the first or
second day after the onset of the disease, but this was not invariably the case.
Out of three pregnant cases treated at St. George's Hospital only two aborted,
and both recovered ; the third (vide Chart XXII), two months pregnant, went on
to full term. When premature labour occurred, both mother and child usually
died. In one case, however, a native woman was attacked by plague five days
before full term ; she was confined the same day and died, but the child was
born alive ; it exhibited no symptoms of plague, and is still living.
The skin was hot and burning to the touch from the first, and continued
dry and harsh until the temperature began to decline on the third or fourth day,
after which it became moist. On the temperature falling to normal or sub-
normal, sweating almost invariably occurred and continued for a few days,
being usually worse at night.
Occasionally before death petechise were observed over buboes or on the .
abdomen ; but no characteristic skin eruptions were seen. In some instances
small patches of skin (unconnected with lymphatic glands) two or three inches
or more in diameter became inflamed, and eventually sloughed, leaving indolent
ulcers with steep overhanging edges. These patches were noticed in some
cases at the sides of the abdomen, and over the loins, where they were in no
way due to pressure or irritation ; but more frequently they occurred on the
extremities, being situated on the dorsum of the foot or hand, on the leg, the
thigh or forearm. Sometimes extensive sloughing occurred, laying bare the
muscles over considerable areas and giving rise to severe haemorrhage. Harely
boils were seen which became black, owing apparently to capillary haemorrhage ;
but no true carbuncles were observed.
Amongst natives the progress of the disease was towards death in about
70% of the cases admitted into the Arthur Road and Parel Hospitals ; among
Europeans and Eurasians treated in St. George's Hospital the mortality was less,
viz., 32.35% and 42.62% respectively. As death approached, respiration became
more and more shallow and feeble, the eyes became sunken, and the patient
passed from a state of muttering delirium into coma, and died, as a rule, quite
quietly from heart failure.
Sometimes the temperature ran up to 107° F. or more before death, and
continued to rise after death ; but more frequently death appeared to occur from
collapse, the temperature falling and the pulse increasing in frequency to such
an extent that it could not be counted. In cases that recovered the temperature