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Symptoms.—The symptoms at the onset of the disease vary 'so very much that
for clinical purposes, I divide the disease into the following groups.
I. Plague Simple with or
without Buboes.
11. Pneumonic Plague with
or without Buboes.
III. Septicoemic Plague.
{
{
(b)
(c)
.(d)
(a)
. ( b)
'(a)
(b)
Mild cases.
Ordinary cases.
Severe cases.
Virulent cases.
Primary pneumonia.
Secondary pneumonia.
Simple Septicoemic.
Septicoemia with one or many blisters, or
blebs.
Glass I.—Plague Simple (a) mild cuses.
In this form the patient goes generally to private medical dispensaries complain-
ing of slight glandular pain, and gives one to understand that he consults only as a
precautionary measure. On examination a lymphatic is found, enlarged and painful
on pressure. His pulse is quick, about 130, and temperature ranging from 99 to 100°.
His looks are frightened, excepting this no other symptom is visible. These cases are
met with just about the time when recrudescence commences, and easily yield to
judicious treatment locally and internally in about 24 to 48 hours. If treatment is
then discontinued on or about the third day there is a relapse with severe symptoms.
These cases are rarely seen in hospitals.
Class 1 (b)—Ordinary Cases—In this, the patient complains of feverish
condition and slight glandular pain. He too generally attends the dispensary
of medical men. On examination he is found to have fever about 100°. He
has furred tongue, anxious looks, slight headache, loss of appetite, and pains in
the limbs. His friends are warned of the danger, but neither he nor they
attach any weight to the warning. He moves about in the house and often
in the streets, even doing some business, when suddenly, on or about the fourth
day, he feels nausea and choking sensations in the chest. He vomits co-
piously yellow or greenish-yellow matter, and simultaneously shivers and is
feverish. On examination the gland seems to have increased in size and is most
painful. The temperature immediately after vomiting is about 102°, and within a
few hours reaches up to 104·°. The pulse which is soft and compressible after vomit-
ing becomes full, bounding, and running with the rise in temperature. The skin which
is cold and moist during the shivering stage, becomes hot and dry within a few hours»
The feeling of nausea persists, and there is heaviness about the head. The patient is
excited, the features get flashed, and he tries to sleep. This is the onset in ordinary
eases.
Case.—Amuabai Mahomed Oomer, age 21, was on the 18th March 1899, brought
to the Khatri Mahoinedan Hospital suffering from Plague. On admission her tempera-
ture was found io be 101°, pulse very soft and compressible, strong feeling of nausea,
face pale, covered with moist perspiration, restlessly tossing in bed. She vomitted
soon after, and then lay prostrate in bed. She did not like to be dis-turbed, speech
suddenly became blurred, face flushed, pulse bounding, but very rapid, 140 r
temperature stood to 104°. The history given by the friend was that she had been
ailing foe the past four days and had pains in the left axilla. She continued to do
household work (for fear of being taken to the hospital) without informing any
one ; on the fourth day she felt her lower limbs as it were paralysed ; on getting up
from bed, she felt intense headache, and then only she told the people in her house.
She was brought to the hospital on the 18th, and became convalescent on the 30th.