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Bowels.—Are generally constipated, moderate purging is always good, excessive
purging is always a bad sign and specially when the stools are black in color; all my
patients who vomited black matter or who passed black stools, died.
Urine.—Is always high-coloured and scanty, it occasionally contains albumen,
suppression of urine is always a bad sign.
Lungs.—The complications are either primary or secondary, such as bronchitis,
broncho-pneumonia, pneumonia, hypostatic-pneumonia; when pneumonia is primary
the prognosis is always grave, we had only one case recovering in 1898, from
pneumonic plague. I have seen a mild form of bronchitis or broncho-pneumonia,
precede death in a majority of fatal cases.
Liver.—In some cases it is enlarged and all the symptoms of acute hepatitis are
present, sometimes jaundice is present; as regards the prognosis, I do not think
hepatitis is a bad sign.
Brain.—-In almost all cases of plague, there are brain symptoms more or less
present, the eyes become red, conjunctive injected, loss of sleep, and often violent
delirium. Convulsions in children are often present and signs of acute meningitis are
seen; sometimes the patient becomes unconscious and remains in that state from a
few hours to 5 or 6 days. I have seen patients with all these symptoms and who
could not swallow a drop of medicine, recover completely. Adults and strong persons
suffer more from brain symptoms (complications) than the weak and the old. We
occasionally see loss of sight and paralysis in plague cases.
Blisters.—They are generally black in color, and are seen only at the end of an
epidemic. I had several such cases under my treatment. Blisters generally appear
on the extremities, they also appear on the stomach and back.
Pregnancy.—There is an impression that if pregnant women get plague, they
generally die; my experience is quite different. I had 4 such cases in Hospital, two
of whom aborted and died, while the two others recovered; (one was delivered of a
male child and both the mother and the child were discharged cured 12 days after
delivery).
Buboes.—They may appear either before, with or after the fever; if the bubo
appears early and the patient takes rest in bed for about a week and keeps himself
on liquid diet, I think each and every such case will recover. Buboes sometimes ap-
pear very late, I have seen cases in which they appeared on the 7th day, such cases
generally prove fatal. There may be more buboes than one. When there is more
than one bubo the prognosis is always favourable. In the beginning there is only
tenderness, it gradually increases in size; the pain becomes intense, sometimes the
pain is so severe, that even if the patient is unconscious and you press the spot,
the patient will cry out. Sudden disappearance of the bubo within the first 5 days
is always a bad sign. The bubo may be as small as a pea or it may be as large as a
mango. I have seen a patient, the circumference of whose bubo was 12 inches, ifc
was very painful and the patient was so restless that I had to cut it open in several
places to rolieve pain, he ultimately .recovered, his name is Mahomed Jaffer Anand,
he was admitted on the 18th January and discharged as cured on the 22nd March
last; about 5 days after the operation, the gland came out. Buboes on both sides of
the neck with pneumonia is a fatal sign. Buboes in the axillary regions are most
fatal. In the majority of cases the buboes suppurated.
Treatment.
Diet: —Milk only to be given, occasionally Brand's Essence of Chicken and
Coffee.