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In the case of a boy, aged 10 years, who had recovered from the acute stage of
an inguinal attack, the liver suppurated. It was incised, and the enormous quantity
of 80 oz. of pus drawn off. He survived the operation about 20 days. There were
four cases of women admitted, who were two to three months preguant : two died
and two recovered ; of the latter class, one was of the pneumonic type, with free
hæmorrhagic expectoration. Abortion did not follow in either of them.
Neither did I observe—as is generally reported—that in women the uterus
becomes a seat of hæmorrhage supervening upon the other symptoms. On the
contrary, some of the cases underwent their catamenial period in a normal manner
while barely out of the acute stage.
Where pregnancy is more advanced ; from four months and upwards, or where
the fœtus is in a viable condition, abortion is sure to occur. I had two such cases
and admitted a third where abortion had just preceded admission, and I have heard
of other, similar results from reliable sources.
There is also a mild form of plague where the temperature does not exceed 100°a
nd is not of long duration, nor very urgent. There is loss of appetite, nausea and
want of energy. Skin hot and dry, restlessness with sleeplessness, and never any
delirium. The tougue, pulse and condition of the eye and countenance are of a
modified type. After a few days the febrile symptoms subside, diaphoresis takes
place, and there are night rises and morning remissions of temperature. A bubo is
present, and rapidly goes on to suppuration, heals quickly ; the whole course of
the disease ending within 12 days.
There were two cases of plague within my observation in which neither
external buboes were detected, nor was there any symptom of pneumonia, but all
the other characteristics of the disease were fully manifested. Whether bacilli
were present it is impossible to say, as no opportunity offered to obtain them. It
is, however, possible that bacilli of incipient energy may have been present to
cause a partial development of their toxic influence, but not capable of producing,
from some obscure impotency, the intensified form of the disease. This condition
of their existence may be partly accepted from the fact that a man was admitted
with indications of plague, but without any temperature above normal. His tongue
was definite, and the only sign to be relied on. He had mycetonia of the foot.
The Russian Medical Officers pronounced it tuberculosis, and it became doubtful
whether the cuse was actually one of plague. A culture was made from material
obtained from within the foot, and in course of time it proved to contain plague
bacilli. So far as actual plague was concerned, this patient never experienced any
symptoms common to the disease. His case is noted in the register of No. 97.
Similarly, another patient was admitted in an advanced state of phthisis with
cavities occupying both lungs. On admission he exhibited unmistakable signs of
plague, and a pneumonic patch could be detected here and there. He had no
buboes. No bacilli were detected in his sputa. He died ; a post mortem was
instituted, and, although the characteristic indications of plague pneumonia were
not present, the culture proved the presence of definite microbes. The form of
delirium met with is either persistent to a fatal issue, or of a passive nature. It arises
from meningeal congestion, due to a high temperature or to a poisoned condition of
the blood. It is of a low type, never accompanied by violence. At most the
patient may endeavour to get out of bed. There is muttering, or incoherent talking,
or a fixed delusion, but no furious shouting. In the bubonic form it is invariably
more active. The pneumonic variety is usually associated with stupor or some-
times with carphology. Occasionally the patient may be roused out of it, speak
sensibly, and relapse again into the same state.
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