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only a few hours or for one or two days. They were generally violent, dull head-
ache or sometimes heaviness of the head and temples, loss of appetite, sense of
oppression in the chest, lassitude, nervous depression, dull pains all over the body and
specially about the groin and in the lumbar region in some oases. There was nausea
often vomiting and constipation. In the stage the temperature did not seem to rise,
or if it rose the rise was very little. Many persons, generally the lower class people
with their proverbial ignorance, used to ascribe all these symptoms to an attack of
bile caused by some irregularity in diet or to change of season, and on this belief,
they remained without any systematic treatment. Two or three days after, when the
illness assumed a grave aspect, and was marked by high continued fever and glan-
dular swelling, the proper medical and hygienic treatment was tried to be given to
the patient. This stage of attack during the height of the epidemic usually lasted but
a few hours, and was soon followed by high fever and great constitutional disturb-
ance. There was great muscular and nervous exhaustion and an over-powering
sensation of fatigue. The illness being only of one or two days' duration, the patient
not expecting that his strength should fail him so soon, naturally tried to exert
himself, but to his utter despair and surprise he used to find that he was unable to
walk or even to stand for a few minutes. When he tried to walk in a particular
direction general trembling set in, and he was inclined to fall down. The patient
showed a gloomy expression of countenance which appeared to be somewhat
characteristic of the plague. The face appeared a little swollen and suffused and the
skin around the eyes, the forehead, and the cheeks assumed a bluish, black or muddy
aspect. The eyes were observed to be glowing and injected, sometimes blood-shot
and a little retracted. The look was generally vacant, anxious, stupid, sometimes
fixed and idiotic. This singular expression though somewhat diagnostic of the
plague did not always indicate the gravity or seriousness of the case. Frequently, in
addition, the speech was thick, faltering and indistinct. The voice when affected was
generally husky and low. These two signs when present, always indicated a bad
prognosis.
The intellectual power and the senses usually became dull, and there was
generally insomnia of the most distressing character. Sleeplessness is one of the
earliest symptoms and is present for days and nights in succession in worse cases.
If a patient sleeps well and naturally, it must be considered a favourable sign.
During the disease, at the commencement the patients were generally quiet, apathetic,
but as the fever rose high and the sensation of internal heat and distress became
extremely unbearable, they threw themselves restlessly from side to side and became
delirious.
The delirium was found to be a common symptom in patients admitted into this
hospital. It was usually of a muttering character, the patient was seen moving his
hands to and fro and sometimes picking the bed clothes.
In a few cases it was of a violent kind. The patient was sleepless, rolled his
head about, cried out loudly, tried to spring from the bed and run away. Such
patients refused all nourishment, and were restrained with great difficulty. This form
was seen usually in young and strongly built muscular patients.
The symptoms of disorder of the digestive tract were as follow :—
At the onset of the disease the tongue usually became bright red at the tip
and edges, and is covered with a white fur. Later on it becomes dry, cracked and
covered, together with teeth and lips with brownish incrustation resembling the
tongue seen in third week of Typhoid fever. The mucous membrane of the mouth
and pharynx is sometimes red and inflamed which is generally found to be an
unfavourable symptom. The appetite disappeared. Vomiting is generally found