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Netvous
Phenomena,
2. Nervous Symptoms.—Certain nervous symptoms were invariably present,
generally showing themselves early during the illness. These symptoms were attri-
butable to perversion of consciousness in different ways :—In some cases there was u
partial loss, amounting to a state of lethargy or drowsiness from which the patients-
could be roused by being loudly spoken to. In other cases of a severe type the loss
of consciousness was complete from the beginning, gradually passing into coma and
death without the patient ever regaining consciousness.
In most of the cases, delirinm was present, varying from slight inooherency
to wild mania, being met with almost invariably at some period or other of this
illness, generally coming on early. In some cases it was of a low mustering type, the
patients lying still, from which state they could be roused to answer questions, how-
ever to gradually pass again into their delirious condition.
Generally the delirium was accompanied with restlessness, illusions and
hallucinations, and in some cases it was of an extremely violent type, the patients
shouting aloud, gesticulating wildly with staring eyes as in acute mania ; they jumped
out of their beds, struggled violently with the ward attendants, and if not properly
secured they would have run away and seriously injured themselves.
Pulse.
3. The Pulse as a rule was increased in frequency, varying from 100 to 180
per minute. In character it might be found to be full and strong in the beginning,
but very soon it became small in volume and lost its tone, so that it could be easily
obliterated. This softness of the pulse was found always to be a very characteristic
sign.
Bubo.
4. All doubt about the diagnosis was removed by the presence of a bubo or
buboes, proper care having been taken to ascertain that they were not of a venereal
origin. A tabular statement showing the position of buboes has been given under
the Table No. VI.
Variety,
A bubo generally made its appearance within 48 hours, accompanied by a
sensation of pain in the region. In mild oases it consisted simply of an enlargement
of a gland, very little painful or tender. In a great majority of cases however, there
was a painful inflammatory swelling of a lymphatic gland with a good deal of oedema
or infiltration of the surrounding areolar tissue. To the naked eye it appeared as a
simple swelling of varying size ; the skin over it normal or faintly red, according to
the degree of surrounding infiltration, which also determined its moveability. Such
a bubo was extremely tender. In other cases it appeared as an inflammatory infil-
tration of cutaneous and sub-cutaneous tissue in which no enlarged gland could be
detected. The affected part nppeared swollen, the swelling diffused, bluish red or
dusky in colour, angry looking, hard and brawny to the feel. Such buboes showed
a rapid tendency to spread in every direction, and were consequently of a serious
nature.
The course of the buboes will be dwelt upon under the progress of the
disease.
In addition to these signs, various other disturbances were produced by the
implication of the different systems in the body :—
Cutaneous
Symptoms.
Cutaneous System.—The skin was noticed to be mostly hot and dry, but in
a few cases clammy and moist, the perspiration having no particular odour.
The colour of the skin generally muddy, dusky, sometimes much cyanosed.
No characteristic eruptions on the skin were noticed.