191
TABLE VII,
Table showing Pneumonic Plague without Buboes',
Female
..
Admission.
74
8
Died.
74
7
Recoveries.
1
Peroentnge o£
Mortality.
ion
87'5
TABLE VIII.
I regret I am unable to supply figures for the actual number of bubonic plague
cusea which developed secondary pneumonia. I am of opinion, however, that about
80 per cent, of such cases show signs of secondary pneumonia generally about the
third or fourth clay.
Clinical
Notes.
All the clinical symptoms of plague have been fully described in the Hospi-
tal Report for the last year, but the following clinical features noticed during the
year ma3 r be found interesting.
Glandular
Relapsing Fe-
ver.
A certain number of cases have come under notice which, i'rom all signs and
appearances, look like cases of bubonic plague. These cases are generally admitted
with high fever, restlessness, delirium, stammering speech, injected eyes, quickened
pulse and respirations and cooing ralos over one or both lungs. The tongue is furred,
there is troublesome vomiting, liver and spleen much enlarged and acutely tender.
There may be hcemorrhages from the various mucous membranes, and in addition
to all these signs one or more buboes are distinctly felt. The buboes consist of en-
larged and tender glands, sometimes in chains, at other times with marked infiltration
of the surrounding tissues. They are chiefly met with in inguinal and femoral
regions, sometimes in axillary, parotid and cervical regions.
Microscopical examination of the blood taken from these buboes showed the
presence of spirochetoeobermoicrii, and the subsequent clinical history also proved that
these cases were of relapsing fever. The buboes generally subsided, but in a few cases
suppuration took place. Some of the cases of what was thought to be parotitis simi-
fcarly turned out to be cases of relapsing fever.
.Dr. Ta}ior very kindly examined some of these cases and confirmed the diagnosis.
Plague Phlye-
tene.
Another clinically interesting phenomenon noticed was that in a certain num-
ber of plague cases a distinct and characteristic cutaneous lesion was met with marking
the spot of the entrance of the plague bacilli into the' system.
The reasons for supposing this lesion to be the seat of tho primary infection of
plague are these:
1. The lesion appears before the other symptoms of infection from plague
and the formation of the bubo.
2. It shows a constant presence of B. Pestis in its contents.
3. It is invariably accompanied by the presence of a bubo in the nearest
proximal lymphatic gland.
This lesion, which has been termed " Plague Phlyetene" by Simond, appears at
first as a small vesicle containing a clear fluid, and shows a slight umbilication. Sur-
rounding it is a zone of inflammatory redness, and the part of tho skin on which it is
situated shows a considerable infiltration. At this stage the contents of the phlyetene
will be found to be a pure culture or plague bacilli. It then goes on increasing in
si/;o, along with the inflammatory infiltration, and the vesicle then gives way near
the central depression exposing a dirty greyish slough at its base. The discharge
now becomes purulent and will be found to contain cocci in addition. If the patient