202
Complications.--The usual complications in a plague case are—headache,
delirium, diarrhoea, vomiting, hiccough, retention of urine, haemorrhage and secondary
pneumonia. Besides these the eyes are very often involved there is either subcon-
junctival haemorrhage or hypopion. Hsematuria is rather rare, haemoptysis and
hsematemesis, meloana being very common this year. Abortion occurred in all
pregnant women, the cases ending fatally.
Mortality.—The plague mortality at this hospital this year has been
very heavy, i.e., 80·8 per cent. 1,001 patients out of 3,104 plague patients admitted in
the hospital died within 24 hours after admission, a greater number dying within a few
hours, and some patients died within a few minutes, and a few were found dead in the
ambulances. 545 patients died within 48 hours. If the number of deaths between 24
and 48 hours be excluded from the total plague mortality, the remainder gives an
average 62·06 per cent, of mortality. It appears that the heaviest mortality was
amongst those patients who had no apparent bubo and most of whom showed signs
and symptoms of pneumonia.
Mortality according to
1.
2.
8.
4.
5.
6.
Axillary
Parotid
Inguinal
Cervical
Femoral
Multiple
*#*
...
·· ·
···
.··
«··
···
...
...
»··
•σι
···
the position of buboes.
···
...
...
···
«··
··»
82—83
82-6
76-80
76-1
76—78
70-9
per cent.
,,
,,
,,
,,
,,
The most important cause of death is failure of heart's action. In cases
of axillary, cervical, and parotid buboes, it is due to extension of inflammation to the
deep connective tissues and the larynx. Haemorrhage from the lungs has been the
immediate cause of death in many cases. Haematemesis was observed in 4 cases,
while hsematuria in δ cases only. Meloena was also a very common cause of death
when diarrhoea supervened.
Convalescence.—Convalescence of a plague patient is extremely tardy and the
patients go on lingering for months together. The shortest period is 20 days and
the longest was 6 months. The wounds and ulcers heal very slowly; the general
strength of the patient is not recovered as in other diseases, but above all some indis-
cretion on the part of the patient or his friends in taking some injudicious food or
over-feeding himself brings on complications, such as diarrhoea, qough, &c., and
retards recovery.
Sequelae.—The sequel of plague is general constitutional weakness which
remains for a considerable time even after the patient is discharged cured from the
hospital. Aphasia and incordination of the upper and lower limbs are seen in a few
cases but it is temporary. The patient gets his speech and power of locomotion
gradually. In two cases it took six months for them to be able to speak well, and
one case lately discharged got tired of remaining in the hospital and requested to be
discharged. Her husband having promised to look after her she was at last dis-
charged partially cured of her aphasia. In one case there wa,s asoites due to incorn-
petency of the heart. In some cases there is arthritis which remains for a long time
after the patient has been convalescent.
Incubation.—It is very difficult to state the exact period of incubation in
plague. The class of people admitted in this hospital are always not exact in their
statements as to facts. They always state that it was only the first or second day of
the attack, but from what has been observed amongst the contacts it could be easily
said that the incubation period varied from 3 to 7 days, In one case only I have