39
Plague complicated by Pregnancy ; Death on 22nd day.
Register No. 374, Hindu, female, age 30, coolie (laborer), admitted 17th April
1897 at 2 p.m. from Sewri ; ill one day.
History on the night of 16th.—Patient had an hysterical fit followed by shivering
fever, headache, vomiting and delirium. Bowels constipated three days, and buboes
appeared at 10 a.m. on 17th in the left femoral region. Present state, 5 p.m. 17th—
Dorsal decubitus ; eyes suffused and muddy. Eyes and mouth open ; patient can
answer questions incoherently ; seems in a state of delirium tremens. Tongue coated
with thick even white fur increasing towards the back. No sordes. Skin very hot
and dry, temperature 105.4° F., pulse 144 full and bounding, respiration 60. Liver and
spleen not enlarged. Heart and lungs normal. Uterus felt two fingers breadth below
umbilicus. Belly painful, and pressure over uterus causes her to screw up her mouth
and eyes as if in pain, and she does this at times when left alone, possibly from initia-
tory uterine contractions. Uterus tender, but rhythmical contraction not made out.
Patient pregnant six months. Bubo the size of a haricot bean in left of Scarpa's triangle
at its upper and inner part, very tender, with surrounding oedema. Patient feels thirsty
and complains of headache when roused. A vesicle on dorsum of left foot, very tender,
size of two-anna piece. No eruptions on 18th morning. Temperature 103.2° F., pulse
116, respiration 46. Tongue furred, delirious, pain in abdomen, eyes injected, gland
tender with increased soft œdema around. Bowels moved twice. Pulse soft and com-
pressible, laughs senselessly. Talks incoherently. Busy delirium present. Says she
has no headache, but belly pains at times. 18th V.—temperature 103° F., pulse 120,
respirative 46. Delirious, restless and laughing in a pleased unconscious manner. Eyes
injected and «pen, pupils normal. Bubo larger, walnut size, hard and very tender.
Morphine ¼ gr. given, and opium 2 grs. as uterus was tender and contracting rhythmi-
cally. Aborted at 5 p.m. Fœtus six months, examined at 6 p.m. by German Com-
mission experts who did not find plague bacilli in its tissues or blood. The mother's
blood gave nucio organisms by cultivation on agar. Bacilli found in vesicle on dorsum
of left foot. On 19th morning temperature 102.4° F., pulse 130—140, respiration 54.
Tongue covered with dirty brown dry fur. Busy delirium and carphology. No sleep.
Pain in abdomen. Eyes injected, pupils normal. Abdomen distended and very
tympanitic. Jactitation. Lochial discharge not foetid. Injections of Condy and boric
used three times daily. Bubo size of hen's egg with increased surrounding œdema, and
very hard and tender. Urine passed unconsciously in bed. Liver dulness obliterated.
19th V.—Temperature 102.6° F., pulse 132, respiration 36. Quiet and sleeping.
Abdomen very distended, obliterating liver. Dulness. Passed one motion. Tongue
cleaner. Eyes less injected. Seems sensible when roused, but soon lapses into busy
delirium like that of delIrhim tremens. On 20th morning temperature 100.6° F., pulse
120, respiration 48. Seems conscious and better. Tongue clear, bowels regular;
lochia not offensive.
20th Y.—Temperature 100.6° F., pulse 108, respiration 48. Takes food, slept
five hours, groans and moans in her sleep. She is conscious and intelligent. Passed
two very offensive motions and vomited twice after food. Discharge suddenly stopped.
On 21st—24th. Restless, refuses food. Tongue furred at back. Eyes injected.
Babbling delirium. Abdominal distention disappeared. Bubo smaller and less painful ;
and she seems worse generally.
On 25th morning temperature 100° F., pulse 90, respiration 36. Prostrate,
restless ; has to be fed by enemata as she refuses food, &c. Does not sleep. Tosses
about in delirium, at times quiet, busy and rambling. Bubo tender ; abdomen flaccid»
Lochia again appear and offensive. Uterus washed out with 1 in 5,000 sublimate.
Passed three very offensive motions.