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Class IL—(α). Primary Pneumonia.—In most ¡cases the onset is-sudden and
fever, bubo and pneumonia all three occur simultaneously. In my observation I
have found that in most pneumonic cases the respiratory system was not
healthy before.
There had been Catarrh or Bronchitis or Emphysema or
Tuberculosis, or the patient was a drunkard, a hard smoker, a pan and
tobacco chewer or an opium-eater. At the onset pneumonia is found in its
first stage, viz., that of congestion. The next stage, viz., that of engorgement
sets in within a few hours, and should the patient live, exudation commences
within 12 hours. The stages follow one after the other in very rapid succession.
The symptoms at the onset are the same as described above under heading (c)
severe cases, and (d) virulent cases, with the addition of symptoms of ordinary
croupous pneumonia. If the latter be lobular, i.e., a few dull patches are
discovered, the prognosis is often favourable, but 'should the whole lung be
infected, the chances of recovery are few. The fatal sign is when streaks of
blood appear in the sputum. When this appears the chances to recovery are few.
Besides pain, dispnoea, high temperature, the one noticeable symptom is difficulty
at deglutution. The patient, after vain attempts to s\vallow food or medicine, spits about
him, sometimes right in to the face of the persons standing by as if he did it purposely,
such is the onset of Primary Plague Pneumonia.
Case.—Oomer Usman aged 15, was admitted to the Khatri Mahomedan
Hospital, on the 6th March. On admission his temperature was 104·2, pulse 130,
rapid, running, skin dry, tongue furred, conjectivse injected, complained of severe
headache.
Examination.—A large inguinal gland, Rales and crepitations in both the
lungs, chest hyper-resonant, breathing hurried. Next day fever went down to 99 in
the morning and again rose to 104 in the evening. Body was cold. Skin moist
and dullness all over the chest. He felt very comfortable till 2 p.m., when
the riso commenced, and then he passed to a drowsy condition from which he
never recovered. On the 7th he was very uneasy, tossed about in bed, speech
became blurred, and streaks of blood appeared in the sputa. He refused nourishment
as well as medicine, and when pressed to take it would spit it out. On the 8th, cold
perspiration set in, respiration became embarassed, heart began to fail and
he died.
Class II.—Pneumonic Plague (δ) Secondary.—This I consider to be merely a
symptom of the failing heart, rather than a complication. In most cases a bruit
manifests itself with the first sound of the heart. I consider it to be a mere acute
mechanical congestion of längs through weakness of the heart.
Class III.—Septicamic Plague (a) Simple Septicoemea without Blebs. In this
variety the symptoms at the onest are the same as described above in Class I (b)
and (c), ordinary and severe plague cases, but the buboes are characteristic in
appearance. More than one, as many as four, five or six, may appear at once, or there
may be none at the onset ; then after a time one may appear, and just when
convalescence is expected, another one is seen ; then a third, and so on—one almost
every week. After two or three have appeared, further development may get arrest,
ed, or they may continue to develop until the patient dies of exhaustion.
Case—Hajee Vulee, living at Kolsa Moholla, was attacked last year by a series
of five glauds in the neck, which included two cervical, two maxillary and one parotid,
forming a swollen mass below the face, as big as the face itself. Two more were
in the axillae and two in botb the groins. The boy died on the fourth day.