74
[CHAP. II.
unhealthy ulcer, with ragged, overhanging edges and a greyish sloughing base, on which
one or more necrosed lymphatic glands might be seen. Such ulcers usually took weeks to
heal and gave rise to large thickened cicatrices. In cases where suppuration did not take
place, the glands remained hard and indurated long after convalescence was established.
The nervous system was markedly affected in almost every case from the beginning of
the fever. The patient complained of extreme feebleness and prostration ; in many cases
he could only walk with the greatest difficulty, and was sometimes unable even to leave
his bed. There was some loss of sensibility to touch, and often the general cutaneous
sensibility to pain also seemed impaired, but in a few cases there was marked
hyperæthesia.
Intelligence was generally unaffected at first, hut sometimes the patient appeared to be
dazed and stupid and totally indifferent to his surroundings. Memory was defective, or he
was unequal to making an effort of memory when asked, for example, to give the date of attack,
or to state what his symptoms had been. In a number of cases, owing to inco-ordination of
the lingual muscles, there was thickness of speech like that caused by alcoholic poisoning, and
this symptom was so characteristic that the attendants in hospital carne to look upon it as a
certain sign of plague in cases where enlarged glands had not already appeared. Later in
the disease dumbness not infrequently occurred from paralysis of the laryngeal muscles. In
addition to loss of muscular power in the upper and lower limbs there was tremor and twitching
of the muscles of the hands, and in many cases marked loss of co-ordination also, causing
clumsiness of movement in the hands, and giving ι rise to a staggering gait on attempting to
walk. As a rule, there was loss of expression, owing to relaxation of the facial muscles, giving
the patient an apathetic or a stupid look, and masking the approach of death. Occasionally at
the beginning of the illness the expression was anxious. In a number of cases cerebral symp-
toms were present from the commencement of the disease and continued day and night through-
out the attack, taking sometimes the form of delirium and at others that of coma. The delirium
was of the busy type, like that of delirium tremens, and was often accompanied by illusions
terrifying in character, from which the patient tried to escape ; among children convulsions
frequently took the place of delirium. In cases marked by stupor the mental faculties appeared
to be paralysed, the patient lying in a comatose condition, from which he could only be roused
with difficulty, if at all. Such cases generally died within the first two days, but sometimes
even within 24 hours.
The respiratory symptoms were hurried breathing and a sense of oppression and tightness
across the chest. In most cases congestion of the bases of the lungs occurred early, and was
rapidly followed in many instances, particularly during the cold months, by bronchitis, by
œdema of the lungs, or by secondary pneumonia. In these cases of secondary pneumonia the
expectoration was bronchitic in character, and after a short time became profuse and watery,
often showing a considerable colouring of blood. These blood-stained serous sputa, owing to
the patient's clothing becoming reddened by them, sometimes gave rise to the impression that
haemoptysis had occurred. Primary plague-pneumonia was also met with, but this form of
plague (which was first recognized and described by Surgeon-Captain Childe) during the present
epidemic is so important as to require a detailed description.
In connection with the digestive system, the occurrence of vomiting at the onset of the disease,
in some instances accompanied by diarrhoea, has been referred to above. In some cases nausea,
vomiting and diarrhoea, appeared at the onset and persisted throughout the whole course of
the attack. The vomited matter was at first bilious in character ; afterwards it contained only
water and such liquid nourishment as had been taken. Diarrhæa, when it occurred, was also