12
are : —The onset is sudden, usually ushered in by a well marked rigor; the tempera-
ture shows a high initial rise in most cases, followed by a marked remission
to normal (or a little above or below it) on the second, third or fourth day
(vide Chart XXIV) ; the pulse large and full at first, becomes peculiarly
soft and is characterized by a great want of sharpness in stroke; it is very com-
pressible at an early stage and dicrotic, but the diorotism is not very easily
recognized by the finger; the aspect is dull, heavy and apathetic, and the
patient has a peculiar stricken look ; the eyes are dull and muddy looking, the
conjunctivae are suffused, but the pupils in most cases are normal ; there is
generally flushing of the face ; diarrhoea when present is simple, but very
offensive; delirium and other cerebral disturbance occur early, and there is
great prostration from the first ; abdominal distension occurs early, on the third,
fourth or fifth day; the eruption is not readily effaced and is of a "deep red
colour (petechial) " ; there is severe pain lumbar in many cases.
During the present epidemic no cases of glandular fever among children
or young adults were met with; nor did an outbreak characterized by the
appearance of buboes, and ac3ompanied by a little or no constitutional disturb-
ance, precede or accompany the outbreak of plague in Bombay. Until bac-
teriological diagnosis has settled that the microbe in these cases is the plague
bacillus, it is premature to speak of them as cases of benign plague. In
Calcutta a number of cases of this sort occurred over twelve months ago, but up
to the present no outbreak of plague has followed.
The bacteriological diagnosis of plague has been purposely omitted, as it
will be given in full detail in M. Haffkine's report. Besides, it cannot be
carried out in practice by medical men who have no special bacteriological
training nor access to a laboratory, and as they are the first persons who com3
in contact with the disease, it is of especial importance that they should be able
to recognise plague cases by their ordinary clinical features.
The prognosis of plague is always exceedingly grave, as it is the most fatal
of all known epidemic diseases. Dr. Viegas, who practises on the Port Trust
Estate and was the first to notice the presence of plague in Bombay about the
third week in September 1896, states that the mortality during the first four
weeks after the outbreak was discovered lay between 95 and 99%, and between
the end of October and the end of November between 85 and 90%.
The mortality in 1,579 cases treated in the Arthur Road and Parel Hospitals
was 69.54%. In the Poona Plague Hospital, out of 1,130 patients admitted, 757
died, giving a mortality of 67%.
In the House of Correction, Byculla, however, where the entire number of
those attacked were admitted into hospital at once, only 17 persons died out oí:
33 attacked, or 51.51%. These prisoners were all adults between 20 and 50
years of age, in good bodily health, and carefully attended to from the time they
fell ill.
In Damaun, out of 110 persons living in the same families, 5-1 were attacked
by plague, of whom 37 or 68-52% died.
Under ordinary conditions therefore the mortality among those attacked
during the present outbreak was probably between 65 and 70%.
Looking at the mortality, according to race and caste, among the patients
admitted into Arthur Road and Parel Hospitals (Table II), the highest mortality,
71.25%, occurred amongst Hindoos; then follow Jews with 68.67%, Native
Christians with 65.45%. Brahmins with 65.21%, Parsees with 64.29%, and
Mahoniedans with 64.24% : the number of Jews (9), Brahmins (23) and
Parsees (14), however, were too small to give reliable results.
Among Europeans and Eurasians a much lower death-rate, 38.95%,
occurred, owing most probably to their possessing more stamina, and being'
treated earlier and more carefully nursed during the attack. Out of 34
Europeans admitted into St. George's Hospital 23 recovered and 11 died, the
percentage of deaths to attacks being 32.35%, while- out of 61 Eurasians under
treatment 58 recovered and 37 died, or 42.62% of deaths to attacks. Table I.