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lymphatic glands exist, the usual ones affected being those of the femoral region,
and those less commonly affected being the glands of the anterior axillary and cervical
regions. The swellings sometimes appear at the onset, usually on the second or third
day, and often not until later, in the course of the attack. They consist of single
glands, chains of glands, or two or more separate glands agglomerated into a mass.
The skin over them is warm, tense if the bubo be large, and very tender. Sometimes
they subside and gradually disappear. Very often they suppurate and burst, and u
sudden rise of the temperature in the course of an attack generally indicates the
appearance of a fresh bubo.
The tonsilar type is a very peculiar one, and is characterized by great swelling
of the tonsils and the glands of the neck on one or both sides. There is also nasal
catarrh, and the appearance of the patient is strange, with the large swollen neck, open
mouth, and inflamed sore nose, from which secretion runs. The great dangers of
these cases are asphyxia from œdema, and cellulitis extending down into the chest.
The septicœmic type is characterised by an intensity of the general symptoms due
to direct entry of the virus into the blood. Enlarged glands may appear in several
regions later on.
The pneumonic or thoracic type is that variety in which the lungs are primarily
infected, most probably by inhalation of the virus, and one or both of the lungs are
attacked most commonly with lobular pneumonia, although conditions indicative of
lobar pneumonia are also sometimes found. An abstract of the report of the Russian
Plague Commission read by Professor Wysokowicz before the Bombay Medical and
Physical Society shows that after a certain period the patches of the lobular pneumonia
coalesce so as to form circumscribed areas of exudation in healthy tissue, and that the
whole lobe is never consolidated in plague pneumonia, as it is in lobar pneumonia.
This type is very fatal, and in severe cases is occasionally complicated with the
development of external buboes, which arise from a secondary extension of the
virus.
The gastro-enteric or abdominal type as a primary form of plague is rare, and the
earlier symptoms are difficult to distinguish from those of the tropical enteric fever
which they greatly resemble. The diagnosis would mostly depend upon the
general symptoms and the peculiar form of the abdominal symptoms which are its
leading features. The eruption, if there is any, is more petechial in character ; the
abdominal distension appears early and has not the signs of that which occurs in
typhoid ; also there are severe lumbar pains, retching and vomiting, and inability to
gain rest except in certain postures. If diarrhoea occurs, the characters of the stools
do not resemble those of typhoid ; the bowels may be inactive, but this is by no means
a criterion, as many cases of tropical typhoid fever are accompanied with constipation
in the early phases. The diagnosis must rest on the recognition of the general symptoms,
the early appearance of abdominal distension, the characters of the stools, and bacterio-
logical tests, and examinations of the blood. A variety of this type has been seen which
is choleraic in character, the predominant symptoms being an imperceptible or only
slightly perceptible pulse, cold extremities, and excessive vomiting and diarrhœa. The
presence of a high temperature as indicated by the thermometer · would indicate the
nature of the disease.
A symptomatic effect which has been seen in the glandular form of plague is
one of hydrophobic symptoms. It has been described as a hydrophobic type, the
prominent symptoms being a terrified expression, difficulty in swallowing fluids,
inability to spit or expectorate, and extreme restlessness. The fever and the bubo
reveal the true nature of the illness, and the hydrophobic symptoms may be a hysteri-
cal display of the terror with which the disease is associated.