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of the glands or to effusion or serus or sero-sanguinous fluid in the cellular tissue
around the glands. It varies in extent and intensity in various cases. It is of grave
import in cases of axillary and cervical buboes as it involves the vital parts. Once
a bubo has appeared, it ends either in resolution, or suppuration and sloughing.
Sometimes a bubo remains indolent for a long time before it effectually sup-
purates. In four-fifths of the cases which are likely to recover, the bubo suppurates,
but in some it is also accompanied by sloughing. The extent of sloughing varies a
great deal. It may be confined to the skin and the connective tissue over the area of
infiltration around the bubo, or penetrate deep beneath the sheaths of muscles expos-
ing them. This is generally the case when the bubo is situated in the femoral or
axillary regions. In the Scarpas triangle the sloughing is so deep that the muscles,
superficial arteries and veins are laid perfectly bare as if the part was perfectly dissect-
ed. Two such cases were seen in this hospital and wound was so deep that one could
easily pkce his fist in it. The same is the case in the axilla, but there the infiltration
is so much that a large surface of the pectoral muscle is exposed, the vital parts are
involved and there is speedy termination of the case. In one case after the slough
was removed tetanus set in and the man was carried off within two days, Slough-
ing is also caused by the application of marking nut or by actual cautery to which
the poor natives resort with a hope of curing the patient. Out of 595 cases
which recovered the buboes suppurated in 482 only.
Blebs or Blisters containing serous fluid were sometimes seen on various
parts of the body of a plague patient. It starts aa a small bleb or blister, the skin
of the part becomes dark green and icy cold. The patient puts down the swelling to
the formation of a guineaworm, and insists upon his suffering from that disease and
not from plague. In one case a gangrenous patch appeared on the left lobe of the
ear which I think a very uncommon position. Ulcers or carbuncles are seen in
some cases. They generally begin as a small hard nodule under the skin, which
sloughs in the centre while the surrounding surface rises above the centre and is of
stony hardness; then it undergoes peculiar changes, and the tissue below it die and
leave a cup-shaped depression. One case worth noting here was that of a Maharatha
youth aged 22 years, who was admitted in the plague ward for fever and right
femoral bubo. He first showed a small nodule on the right cheek, this was ordered
to be poulticed, next day a depression was seen at the place of the nodulo and the
surrounding surface became hard and indurated and the whole face swollen. Poul-
tice was continued, but the next day the face became more swollen and the patient
was not able to swallow without difficulty, as there was fluctuation perceived in the
swelling an incision was made into it, but nothing came out. Poultice was continued
next day the whole face was erysipelatous and the man was not able to swallow, but
under treatment the swelling gradually went down, the slough came off, and there was
a large angry-looking nicer left. This gradually healed and the man was discharged
cured.
Abscesses.—Abscesses are formed in various parts of the body, especially in
septicsemic form of plague. They burrow and form long sinuses, very troublesome to
heal and exhaust the patient's strength. A case of septicaemia abscesses worth noting is
that of a boy 13 years old, admitted into the hospital, with right femoral bubo. He
appeared lively on admission, but was found delirio as in the evening. In the morning
it was noticed that he had gnawed his two fingers up to the second phalanx, and,
apparently he had swallowed the pieces he gnawed. He used to take all his food,
but was not conscious and always lay prostrate on the back. Later on, the femoral
bubo sloughed and left a dissected ulcer in the scarpa's triangle, and eleven abscesses
formed one after another from the head to foot, all these were opened; but those