268
The height of the temperature afforded no certain criterion of the severity of the
cases, and though the temperature seemed to keep down low, it was not safe
to give a favorable opinion, because of its abatement, as patients with high and low
temperatures were seen equally to succumb to the disease.
Bubo.—The most characteristic phenomenon of the disease was the swelling of
the lymphatic glands. It appeared either at the beginning of the fever or much
more commonly in the course of the first 4 or 5 days of the disease. The percentage
of cases treated in the hospital in which it was present was 86. It appeared in one
or more parts of the body, and varied in size from a bean or small almond to that of
a hen's egg,
The size and situation of the bubo, though not sure indicative of the gravity of
the case, affected its course to .a considerable extent. It was observed that the smaller
and more tender the bubo was, and attended with high pyrexia, the greater was the
danger, while an early appearance of the bubo and its early inclination to suppurate
were looked upon as favourable symptoms.
The bubo developed itself frequently about the groin and the femoral region. It
also developed in the armpit, the angle of the lower jaw and the neck. In exceptional
cases it was found in the side of the chest and the elbow joint. As a rule it appeared
in one of these places only, but in few cases it appeared simultaneously in more than
one place.
It might be either superficial and palpable, or internal, or a combination of both.
Amongst the internal glands, those of the intestines were chiefly affected as could be
made out by the abdomen being very tender in such, cases.
In 215 cases in which the bubo made its appearance, it was localized as follows:—
Femoral
Inguinal
Axillary
Cervical
Multiple
77
53
52.
II.
22.
Character of the Bubo.—The affected gland was swollen and increased in size and
was always tender and painful, so much so that even when the patient was comatose,
moderate pressure on the gland caused moaning, indicative of the suffering produced
thereby.
As the disease progressed, the bubo got inflamed and there was a marked in-
filtration, hœmorrhagic or serous, in the glandular and cellular tissue surrounding it.
The inflammation was not confined to the single lymphatic gland first affected,
but it spread usually to the neighbouring glands also. The skin over the bubo then
became red and œdematous and a hard painful swelling was thus formed. In the cases
that recovered, the bubo suppurated, and when opened it gave out pus and other in-
flammatory discharges. It usually suppurated from the 10th to the 14th day of the
illness, and it required generally one or two months to heal completely.
Complications.
Brain symptoms—Congestion was found to be very common as was evidenced by
the presence of delirium in many cases. True meningitis was observed in only two
cases of children, both of which proved fatal. On account of the toxœmic condition of
the blood, the intellectual powers appeared to have become dull, but in most of the cases
no symptoms indicative of any organic lesion in the brain were seen except in cases
where speech was affected. However, when the patients became convalescent., the
power of speech was restored.