MEDICAL ASPECTS OF PLAGUE.]
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day or third day, the temperature falling to normal between the fifth and seventh days
(vide Chart XXI). But in relapsing fever there is giddiness ; prostration is slight ; jaundice
not infrequently occurs on the third or fourth day ; the face is flushed, and the expression
is not stupid nor confused ; buboes are not met with ; and spirilla are found in the blood
during the height of the fever.
Plague in its onset and early symptoms somewhat resembles typhus fever. But the
duskiness and flushing of the face present at the beginning of typhus fever, and the occur-
rence of an eruption on the body and limbs between the fifth and seventh days, as well as
the different course of the temperature (vide Chart IX), and the absence of buboes would
serve to distinguish between them.
Owing to the feebleness, thick utterance and staggering gait, frequently seen in plague
cases, the disease is sometimes mistaken for alcoholic poisoning. The following is a typical
case. Govind Jeeva was taken by his friends for treatment to a qualified medical practi-
tioner. They stated that he had had a fall, and the following note of his case was made :
"Pupils slightly dilated, breath smells very faintly of alcohol, has a slight contused wound
over but not exposing malar bone," and an emetic was prescribed. Fortunately this was
not given. Nest day a note was made as follows : "Bowels not opened for two days ; is nofe
quite recovered from the effects of drink," and on the following day : " Speech indistinct,
temperature 102° F., bowels not opened.'' On the fourth day he died. In this case enquiry
showed that the patient had been two days ill with fever, and was given a little alcohol after
having fallen down in a faint. He was seen by another medical man shortly after the
emetic was prescribed, and found to have a very frequent and feeble pulse, fever, and a
typically coated tongue. The diagnosis of plague was made and afterwards verified by
post-mortem examination. Had the case been one of alcoholic poisoning, there would have
been a full and bounding pulse, a normal or subnormal temperature, and considerable
mental excitement ; or in a later stage drowsiness, or coma with stertorous breathing, a
slow and compressible pulse, and a subnormal temperature.
In plague cases where abdominal symptoms are marked and a typhoid condition has
supervened, the diagnostic features given by Captain Hojel are :—The onset is sudden,
usually ushered in by a well-marked rigor ; the temperature shows a high initial rise in
most cases, followed by a marked remission to normal (or a little above or below it) on the
second, third or fourth day (vide Chart XXIV) ; the pulse larger and full at first, becomes
peculiarly soft and is characterized by a great want of sharpness in stroke ; it is very
compressible at an early stage and dicrotic, but the dicrotism is not very easily recognized
by the finger ; the aspect is dull, heavy and apathetic, and the patient has a peculiar stricken
look ; the eyes are dull and muddy looking, the conjunctive are suffused, but the pupils in
most cases are normal ; there is generally flushing of the face ; diarrhoea, when present, is
simple, but very offensive ; delirium and other cerebral disturbance occur early, and there
is great prostration from the first ; abdominal distension occurs early, on the third, fourth
or fifth day ; the eruption is not readily effaced and is of a " deep red colour (petcchial) " ;
there is severe lumbar pain in many cases.
During the present epidemic no cases of glandular fever among children or young adults
were met with ; nor did an outbreak, characterized by the appearance of buboes, and accom-
panied by a little or no constitutional disturbance, precede or accompany the outbreak of
plague in Bombay. Until bacteriological diagnosis has settled that the microbe in these
cases is the plague bacillus, it is premature to speak of them as cases of benign plague. Ια
Calcutta a number of cases of this sort were seen, but no outbreak of plague occurred for
over 17 months afterwards.