88
On 15tli in much the same state as last noted. Restlessness, jactitation, low
muttering delirium, and no sleep at night. Bowels constipated. Tongue furred.
Teeth covered with sorties, and lips dry.
On the 16th at 8 a.m. a bubo noted along the anterior border of the right trape-
sius, isolated, bean-like and very tender, also two small buboes in the submaxillary
region on right side. The whole body pains. No delirium at present, but slight
incoherence. Headache temporal in situation complained of and much thirst.
Tongue clearing in patching in centre and front, leaving raw, red nonfissured areas.
Left axillary bubo larger and very tender with œdema, obscuring its limits. No com-
plications. Patient menstruating for the first time since September last. Injected 60
minims of hydrarg perchlor, at 10 a.m. in left arm below bubo. Same day at 5
p.m. temperature 104.6° F.; pulse 120, very compressible, respiration 40. Cephalal-
gia frontal and severe. Bubo less tender. Patient sleepless, thirsty, without appetite.
Motions and urine, passed naturally. Tongue with thick brownish-white fur, chipping
oft in large flakes, leaving raw red areas.
At 9 a.m. on 17th, temperature 105.4° F., pulse 120, respiration 36. Breathing
hurried and painful in right side. Slight cough and muco-serous expectoration,
tinged with blood at times.
Physical signs of broncho-pneumonia in patches. Patient prostrate, sighing-,
and moaning, and delirious at times. Conjunctivæ injected, especially at canthi, more
delirious at night. No sleep. Constant cough. Menstrual discharge profuse ; foetid:
does not contain specific micro-organisms of plague.
At 7 p.m., temperature 105.4° F. (fell to 102° F. 6 a.m. when broncho-pneumo-
nia was developed) ; pulse 130; respiration 36, quick and shallow. Pain in right side.
Expectoration and cough constant. Sputa yellowish-red at times. Tongue with
two patches of raw red appearance ; the size of sixpence each. Drowsy, slept with
delirium between, for half an hour at most ; very thirsty and prostrate. Anorexia
complete. Unconscious and with low muttering delirium, but can be roused to answer
questions, Bowels constipated, urine passed naturally. Very anæmic. Left axillary
gland very tender.
On 18th, cough and pain in chest markedly increased. Tongue and general
symptoms and signs unimproved. Menstruation profuse and still foetid in spite of
frequent injections of Condy's fluid, borax lotion, and sublimate. Patient was
found sitting up gasping for breath and the pulse became small, short, rapid, irregular,
and almost indistinguishable.
On 20th, the notes read—Prostrate, anæmic, unconscious and delirious. Mucous
rales at both bases behind. Expectoration muco-purulent and blood tinged. Res-
pirations, gasping irregular, 48 per minute ; in the evening 66 per minute. Bubo
exquisitely tender and œdema obscuring it.
On 21st semi-conscious. Respirations, gasping and gurgling, 60 per minute.
Eves staring, injected, wide open with pupils dilated. Much jactitation. Immense
swelling of tissues around neck, under-jaw, obscuring features. Tongue crusted brown,
sordes on lips and teeth and " typhoid state " generally, and death with stupor and
profound coma at 2-30 p.m.