200
in the arm and leg had burrowed to such a length that they had formed communi-
cation with abscesses situated in the other end of the leg or arm. The boy at last
died 21 days after admission in the hospital. He was ailing for 13 days before
admission.
Petechia.—Small hemorrhagic spots have been observed in two cases only in
this hospital. They covered the greater part of the body, especially the back and the
shoulder. A Brahmin boy, aged 18, was admitted for fever in the hospital, next day
he developed a left femoral bubo and was transferred to the plague ward; on the next
day small hemorrhagic spots were observed all over the body, which disappeared on
the fourth day. The bubo subsided and the boy was discharged cured. The case was a
complicated one as would be seen from the Temperature chart, which is that of relaps-
ing fever, but the development of the bubo is most puzzling.
Eyes.—Eyes as a rule are injected and suffused in every well developed
plague case. In some cases there is siib-conjunotival hemorrhage, while in others
there is ulceration of cornea, prolapse of the iris and total destruction of sight. A
case admitted in this hospital and still under treatment and worth noting is that of
a Pardeshi gardener. He was admitted for plague in the plague ward. His eyes
were ecchymosed and there was a white ring round the upper half of the cornea,
pupils were drawn upwards and the patient was not able to see anything. Gradually
the ecchymosis and the redness subsided and the eyes looked as if operated upon
for cataract, this appearance remained for a long time and his sight began to recover
gradually, now the eyes are quite normal and he can see everything very clearly.
Tongue.—Tongue is characteristic. It is dry, covered with a thick white fur ;
as the case gets worse the fur becomes yellowish brown or even blackish.
Vomiting.— Fomiting is very common in plague. It is often yellowish in
colour and has sour abid smell. In many cases it is persistent and is very difficult to
control. Sometimes a patient vomits large quantity of blood and dies all of a
sudden.
Hiccough, is a very distressing complication, but is not very common. It
yields to remedial measures, but soon reappears. In one case it persisted for twelve
days and then disappeared, but it is more observed in relapsing fever cases, where it
commences two or three days previous to the expected relapse, and persists during
the time the temperature is high.
Constipation, is complained of in many cases and the patient feels relieved
after a dose of a purgative mixture or a copious enema of soap and water.
Diarrhcea, is another distressing complication, the stools are very offensive.
It does not easily yield to treatment and indicates a speedy termination of the
case.
Pulse.—The pulse of a plague patient varies in its frequency, force, volume,
and tone. The full and bounding pulse associated with high fever is generally
absent and in its place we find a feeble, frequent running pulse, with a tendency
to become intermittent or often distinctly dicrotic, and then there is failure of heart's
action. It may be gradual or sudden. In the former, the pulse becomes
imperceptible, temperature falls below normal, the skin is cold and clammy and
the patient dies; but when the failure of the heart is sudden, the patient apparently
looking better, talks sensibly, tries to sit up or attempts to get out of bed, after
some such sudden exertion, falls down and dies.