85
On 21st, temperature 303° F.; pulse 120 to 130 ; respiration 48. Passed a rest-
less night. Thirst and delirium markedly increased. Skin perspiring; extremities cold.
Bubo larger, harder, more distinct. Patient very drowsy and restless. This evening
stupor and complete unconsciousness came on with sighing, irregular respiration,
cold extremities, low muttering delirium, and general symptoms of the so-called
"typhoid state," from which, in spite of vigorous efforts and treatment, he never
rallied, and died on the evening of 22nd April 1897.
Plague, Sudden Collapse and Death.
Register No. 396, Hindu, male, age 22, labourer, admitted 22nd April at 8 a.m.,
died at 6 p.m. on 23rd, ill 2 days.
Case from Bhoiwada, house No. 134. There had been no plague in his chawl.
On the 22nd at 3 p.m. he became ill with headache, shivering, vomiting and constipa-
tion ; and he lay down, became unconscious and stupid, and knows not how he got
to hospital. At 9 a.m., on 22nd, temperature 103.8° F. ; pulse 128 ; respiration 36.
Present state.—A strong, muscular man with dull stricken look. Eyes closed,
mouth open, fœtid odour from skin and breath ; lying on his back. Eyes suffused and
injected, especially atboth canthi, when uncovered. Patient unconscious and drowsy;
pupils normal. Tongue thickly coated with even putty-like fur, red at tip and edges.
Body and extremities hot and dry, skin of face clammy, refuses food. Dorsal decubitus :
irritable and restless when touched ; breathes quietly. Liver in the nipple line extends
to the upper margin of fifth rib. Cardiac impulse normal in position, can be seen and
felt, sounds ruffled, no murmurs. Breath sounds harsh in front, and at base of
right lung numerous mucous rales detected.
Liver and spleen not felt in abdominal regions ; abdomen flaccid. An old scar
(one week's duration ?), on right knee, no eruptions or wounds found. A bubo is felt
on right femoral region, size of a walnut, very tender as he evinces when it is touched ;
a good deal of œdema around, and skin movable over it, but hot and burning.
Small, shot like, but soft and non-tender glands felt in left groin ; none elsewhere.
Temperature 103.4°F. ; pulse 120—132 ; respiration 48 at 4 p.m., on 22nd pulse soft
and very compressible, patient in same state as noted in the morning, unconscious and
delirious.
On 23rd at 7 a.m., temperature 104.6° F. ; pulse 120—130 ; respiration 60 and
he became conscious at 5 a.m., slept till roused, and then gave an account of his illness.
Is intelligent, shows his tongue which is furred, white, and large and moist. He
complains of pain in the right groin and headache chiefly. Feels prostrate and weary.
Eyes clear, not injected, but suffused and muddy looking, pupils widely dilated.
Bowels constipated; passed urine this morning.
Bubo more distinct, harder, and very tender; seems convalescent. Blood cultures
on agar disclosed the presence of specific plague bacilli and the case was watched
with great interest, as all such blood infected patients had hitherto died.
At 3-30 p.m., on 23rd, he was conscious and intelligent. Took nourishment
and wanted to sit up in bed. Temperature 104° F. ; pulse 128 ; respiration 40 ;
and looked doing well and as last noted.
On visiting him again at 5-30 p.m., however, a marked and sudden change in
his condition was apparent, eyes greatly injected, pupils contracted, breathing, gasping,
noisy, hurried, 72 per minute, pulse running, thready, and hardly perceptible.
Patient unconscious, collapsed, unable to swallow. Ether was given twice hypoder-
mically, and hot bottles and turpentine stupes applied, but all were of no avail to rouse
the patient from his state of stupor and coma, as he expired at 6 p.m. the same day.