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Class I.—C. Severe Cases. In this form there are no preliminary symptoms
before the regular onset. They are all ushered in at once, The patient is either
walking, sitting, or at work, and suddenly he feels giddy, with nausea,
dimness of vision, weight in the chest; a few minutes after, he vomits
copiously yellow matter and this is accompanied by a severe rigor. He soon
points to some spot in the groin, axilla, &c., where he feels cutting pain. He or
his friends press the part and find a gland. He now knows what has come on.
He lies in a dejected state and passes to semi-unconsciousness, speech becoming
blurred. On examination his temperature is found to be about 104°. His skin is
dry and pale. He breathes hurriedly, pulse is between 120 and 140, rapid, small,
and irregular. He complains of severe headache, nausea, and aching pain in the
limbs. He goes to micturate, but cannot pass urine. A few hours later the
temperature rises by a degree or two. The conjunctivas are injected : he tries to
sleep, but cannot, and says that on shutting eyes he finds all sorts of beasts, &c.,
running before his sight- This last is a prominent symptom, particularly among
young boys. Next morning, he gets up a little better and composed, and complains,
of insomnia, either constipation or diarrhoea but generally the former. The case
then progresses.
Case.—Isa Sooleman, age 45, was attacked with plague, on the 28th February,
and brought to the Hospital on the 2nd March, History.—He was carpenter by pro-
fession and, whilst working, suddenly fell down ; he felt choking sensations in the
chest and vomited soon after. He then had fever, and remained at home for
2 days under the care of his wife. On the 2nd March, when she too was attacked,
both were brought down to the hospital. On admission Isa's temperature was found
to be 104°·8—pulse 140, rapid, full and bounding, but the heart sounds were very
weak. There was already bronchitis which he had for a very long time. He lapsed
occasionally to a state of semi-unconsciousness, but could be roused and made to take
medicine and nourishment and would answer questions composedly. On examina-
tion a large gland was detected in the right axilla. His heart began to fail, and
continued to do so till he died on the 5th March 1899.
Class I.—(d) Virulent cases.—In this the onset is very sudden, the patient
is suddenly struck down unconscious, followed within a few minutes by fits of
convulsions and often death. In many cases, consciousness is regained and the
patient feels drowsy. He finds that his speech is paralysed ; on examination his
temperature is found to stand above 105° pulse is quick and thready. He points to
a place where he feels pain most, and this on examination is found to contain a gland.
Fits of convulsion often recur. In this state he lives from a few hours to two or
three days.
Case.—Mohomedally Adamjee Charter, age 35. After his evening meal, he was
sitting in the verandah of his house at about 7 p. m. He suddenly fell down and was
seized with a fit of convulsions. He was carried in, and a doctor was sent for. He
declared the case to be one of hemiplegia. At 8-30 p. m. I saw him. His tem-
perature was 105°. Pulse weak and thready, looks peculiarly frowning, heart
sounds weak, retention of urine. He had hemiplegia of the left side. A friend of
his called my attention to his left groin, which on examination was found to contain a
large bubo. I pressed it and, though drowsy, he shouted and made distorted features.
I informed his people of the nature of his disease, but they opposed the idea of
his having plague, on the ground that another medical gentleman had called it a
case of paralysis. I waited till the next morning only to learn that he had died
at 10 p. m.