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to be present and uncontrolable in the beginning of the attack. It is generally
bilious or watery, and continuous and obstinate in some cases. Great thirst with
a painful burning sensation in the stomach is usually present. Hæmatemesis was
not observed.
The liver and spleen were also found to be enlarged and painful in few cases.
The bowels are usually constipated and require to be kept open by internal medi-
cine or enema.
Diarrhoea was rarely seen to continue throughout the whole period of the fever.
Disorder of the respiratory system.—Patients with the various signs and symp-
toms of plague enumerated above, excepting the bubo, and with prominent symp-
toms of affection of the respiratory organs, were observed in the Hospital, and these
might be called the cases of the Pneumonic type of the plague. These cases were
rather difficult to be diagnosed in the early stage from cases of true croupous pneu-
monia, but the diagnosis was helped greatly by the absence of the most characteristic
signs such as marked dullness, crepitations, &c., of the latter in cases of plague and in
such cases further confirmation might be obtained by a microscopic examination of
the sputum.
In some cases congestion, bronchial catarrh, and pneumonia appeared as compli-
cation of the disease.
The breathing was frequent generally in proportion to the height of the fever,
but in some cases it was unusually hurried without any obvious lung complication
to account for it, and such cases as a rule terminated fatally.
The Pulse.—At the beginning of the disease it was full, soft, bounding and fre-
quent, varying from 100 to 130 according to the intensity of the fever. But soon
after, within the 3rd or 4th day of the illness, it used to lose its tone and become un-
steady, feeble, small and frequent, which surely indicated that the case was getting
worse and would soon end unfavourably. A gradual fall in the frequency of the
pulse rate is a favourable sign. It was also observed that the cases in which the
pulse remained steady and proportionately slow, even when the temperature rose high,
generally recovered. The heart's sounds were generally found to be normal al-
though the impulse was diffused.
Disorders of the nervous system.—There were muscular twitchings, partial
deafness, insomnia of the most distressing character, nervous exhaustion and de-
lirium as described above. One prominent symptom worth observing was the
marked loss of muscular co-ordination evidenced by the clumsiness with which the
patients handled the articles ; their way of speaking and their inability to walk.
Fever.—It was present in almost all cases, but varied much in height and dura-
tion. No regular typical curve like that of some specific fevers was observed. It
was usually ushered in by one or more fits of shivering. The temperature ranged
generally between 103° and 105°F. But in a few cases, after the first rise to 105°o
r to 107° even, it ranged from 100°F to 103°. The temperature began to rise on
the first day and attained its height on the second or third day, when delirium usual-
ly set in. The temperature continued to be high with slight remissions till the end
of the first week. Then in successful cases it steadily began to go down from the
end of the first week, to the middle of the second week, when it became normal and
continued so in uncomplicated cases ; whereas, when serious complication was present,
it progressed according to the nature of the complication. A fall of temperature by
lysis from the 5th to 7th day is a favorable symptom.