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In these cases of primary pneumonic plague, the appearance of the patient
was found to have quite characteristic symptoms. The expression was very anxious
and frightened, face cyanosed, extreme restlessness, short, hurried and gasping
respirations, cough short, but not troublesome, sputum scanty, frothy, either speck-
led with blood or bloody.
The physical examination, however, was not found to reveal signs of any
magnitude to account for the severity of the symptoms. A careful examination
detected, perhaps, a small patch of impaired resonance, which on ausoullation showed
a few rhouchi and a few small crepitations. The presence of the numerous plague
bacteria in the sputum made these pneumonic cases very infectious : they were,
therefore, kept, according to Ool. Wilkins' suggestion, together in a corner of the
acute ward.
In some of these cases bacteriological examinations were made by Lieuts.
Douglas and Walton, of the I.M.S., who found the sputa in pneumonic plague to be
pure cultures of B. Pestia. (Edema of the anterior thorasic wall was not met with
in a single case of primary pneumonic plague.
Termination
Favorable
Symptoms.
Termination.—The suppuration of the bubo was always found to augur
favorable prognosis. Other favorable symptoms were the fall of temperature to
normal, without any tendency for a subsequent rise; the disappearance of the
nervous phenomena, clearing up of the fur on the tongue and the lessening of the
suffusion of the conjunctiva.
Unfavorable
Symptoms,
The prognosis should be, however, always guarded, for cases that looked favor-
able might suddenly develop prostration, and as the result of the slightest exertion
a patient might suddenly drop down dead. The. presence of complications was
always looked upon as an unfavorable symptom; also convulsions, muscular
witchings and delirium. The tendency for the bubo or the phlyctenule to spread
was also looked upon as a bad omen, so also if the patient kept a high temperature
and showed accelerated pulse and respiration rates.
Treatment
General
remarks.
On coming to the hospital every patient was immediately examined and sent
to the appropriate ward. After admission into the ward he was undressed and
thoroughly sponged over with soap and hot water, all his clothing sent to the
sterilizer to be disinfected, and anything that was filthy was burnt in the incinerator.
Short clinical notes were then taken down by the Hospital Assistants. AIL
the cases of pneumonic plague were kept together.
"With the increase of the number of acute coses, the usual number of Ward
boys and Mehtars had to be doubled in the acute plague ward and even this number
was sometimes found to be inadequate.
All the dying and the delirious were screened off. To cause this to be
carried out in a more effectual manner, the Special Medical Officer had the acute
plague ward divided into 19 compartments, each about 7' X 6', by means of
partitions of bamboo matting about 6 feet high ; but they were found much to
interfere with the work of the nurses and to reduce the ventilation of the ward.
When the weather-frames were put up in the rainy season, they further interfered
with the ventilation, and were consequently removed. The great drawback about
this arrangement was that the compartments were too small, and it necessitated the
employment of a larger staff of ward attendants. There can be certainly no doubt
that the sight of so many patients raving and gesticulating like mad men, and then
suddenly dropping down dead, is quite sufficient to give a most profound shock
to a freshly admitted patient with unimpaired mental faculties—a shock that may
certainly reduce his chances of recovery. I am of opinion that smaller and
moveable screens will better serve this purpose.