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Multiple Buboes.
Case II.—Cassum Mahomed, a coffee-shop keeper, was admitted in the Khatri
Mahomedan Hospital, on the 13th March 1899, with a gland in the left cervical
region. This disappeared on the third day after admission, the temperature going
down about the same time. On the 18th a large-sized gland was found in the left
femoral region. On the 22nd two were found simultaneously·:—one on the left tibea
and one on the upper surface of the left great toe. Simultaneously blebs appeared
in close proximity of the glands. On the 28th a large mass was seen in the right
cervical region, and on the 30th he died. I had one case last year with nine glands,
and the last part to be attacked, about six weeks after, was the liver which suppura-
ted, and the patient died.
Class III.—Sepliccemic Buboes with Blebs.—In this the symptoms at onset are
the same as in the above variety, but with the addition of blisters or blebs either
above the gland or in close proximity of it. They vary in size and shape and colour.
There may be a dark congested spot with or without a bleb in the centre. If the
congested spot, having the appearance of ecchymosis, is left to itself, a bleb forms over
it a few hours afterwards. The fluid in the bleb is viscid, yellowish, and the patient
not only complains severe burning pain in this part but in the whole body. The local
burning ceases after the bleb is opened and a few poultioies applied.
Fever.
I regret, without the assistance of qualified Hospital Assistants or Nurses, tem-
perature charts could not be kept in most cases ; but the temperatures were mostly
noted by me in the papers of cases relating to patients.
Remarles.—In most cases the regular onset begins with the temperature of 102°.
After vomiting it shoots up to 103°, 104°, up to 107°, and rarely to 108°. Next
morning the temperature either falls to 99° or below with an evening rise to about
104°, or it falls to about 102° or 103° in the morning, and rises again by 1 or 2
degrees in the evening. Should the temperature have fallen down to 99° in the
morning with some rise in the evening, it is generally a fatal indication, no matter
how cheerful the patient and his friends look. A temperature of above 105° at
the very onset is again generally a fatal symptom.
Buboes.
These are of two varieties—(1) simple ; (2) with blisters or blebs.
In 1897 the second variety almost did not exist.
In 1898 they appeared just about the time when the virulence of the epidemic
was most severe, and this year they were seen from the very beginning of the recrudes-
cence, leading me to suppose that the virulence of the epidemic would be more severe
this year than during the former ones. Buboes vary in size from a gram-seed to a
large pear, their shape being rounded or elliptical; and when two or more unite
together, as the cervical and the sub-maxillary, they form an irregularly shaped mass.
Situation.—From observations I have come to the conclusion that in most cases
buboes appear about the situation of those glands which at one time or the other have
become diseased. Native children generally suffer from otorrhoea, stomatitis,
apthce or skin diseases of the scalp, &c.; and among them buboes appear in the
cervical, parotid and sub-maxillary region mostly. Among females who have
generally had sore nipples, mammery abscesses or scrofulous enlargements of the
axillary or cervical glands, the favourite situation of buboes is the axilla or cervical