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As to the predisposing causes, prime of life and robust health offer greater
susceptibilities—insanitary dwellings, deficient ventilation and light, dampness in
houses and surroundings, exhausting occupations, overcrowding in infected build-
ings, and want of rest, &c. There is such a similarity in each form of attack that
a technical description of one case will suffice to indicate the symptoms observed.
First in the glandular variety.
There may or may not be a noticeable rigor—indeed most patients denied this—
depression of spirits, frontal headache of a throbbing nature, with a certain amount
of giddiness; an exhausted anxious look, while the eye-lids appear heavy and are
kept partially closed, giving the eye a dull, downcast, and sleepy expression ;
considerable restlessness, and occasionally vomiting, or purging, or perhaps
both ; the excreta being of a bilious kind. Usually, however, there is consti-
pation. If the patient is able to walk, there is a staggering, uncertain movement in
his gait. Weakness rapidly increases till the muscular system becomes powerless.
He feels faint and has an uncomfortable sensation in the præcordial region, and, in
comparison with other fevers, these symptoms invade very early. The countenance
gets more haggard, the eyes more sunken and dull, and, if the temperature be high
(about 104 or 105), there is invariably some congestion of the conjunctivse. The
skin is hot, dry, and harsh to the feel ; the only places appearing to offer any
perspiration are the forehead and neck. The tongue is swollen or considerably
thickened, covered with a fur varying in colour from white to reddish brown ; at
times it glistens towards the centre, looking like old mother-of-pearl, the tip and
edges are moist, clean and red, this redness being more apparent than real owing to
the contrast produced by the fur. The pulse is quick, small and soft, and feels as if
there was a want of elasticity in the coats of the artery. The respiration may bo
short and hurried, the speech is thick or indistinct ; there is an indifference to
conversation, although there is complete sensibility, and pain is experienced in some
glandular region. So intense and acute is this that the very approach of one's hand
towards this spot acts spasmodically on the patient. If the bubo has already deve-
loped, it is of a red colour, and the deeper this approaches to a purple or livid aspect,
the more serious is the prognosis, as such change is no doubt produced by extensive
hæmorrhagic infiltration. Suppression of urine may exist, while in colour it does
not differ to that passed by those suffering from other fevers. There is a distinct
inability to sleep, a craving thirst, and a persistant desire not to acknowledge being
attacked by plague. After a lapse of 12 to 20 hours, and this in relation to the
intensity of the toxine or idiosyncrasy of the individual, the symptoms become
more exaggerated. There is an agitation of impending fear, a restlessness, and
wish to sit up, a constriction about the chest. An oppressiveness, as if sufficient
air cannot be taken into the lungs. A constant change of position, and impatience
towards attendants. Sleep is only temporary and unrefreshing. The patient
wakes in a dazed condition with hallucinations, his mind wanders, and there may be
delirium, and this in proportion to the temperature, subsiding into simple confusion
during periods of remission. These symptoms may alternate for two or three days,
a regular remission being more favourable than a rapid rise and fall of tempera-
ture. Sometimes there is an appearance of coma supervening, which argues an
intensity of the disease. If at the end of three or four days the symptoms present no
indication of abating and become further aggravated, the exhaustion has advanced,
the tongue is parched and tremulous, the fur has assumed a darker hue, the pulse
is exceptionally soft, and markedly dicrotic, quick and labouring, pupils much
dilated, a confused expression of countenance, impediment of speech, so that the
patient cannot pronounce words. The muddy aspect of the eyes is peculiarly
mixed up with a distinct lustre and continues so irrespective of any
symptomatic remission. The tongue has now increased in size, and there may