MEDICAL ASPECTS Of PLAGUE.]
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sometimes occurred on the second or third day (vide Charts XX, XXVI), and was often
attributed to a particular line of treatment when it was really the usual course of the
temperature unaffected by the treatment. The occurrence of complications, e. g., the
appearance of fresh buboes, secondary pneumonia, etc., gave rise to great irregularity in
the course of the temperature (vide Charts II, XIV, XX, XXIII, XXVIII).
Nausea and vomiting were met with at the onset in almost every case, and frequently
continued for the first day or two. Splitting frontal or general headache was present
from the first and continued while the temperature remained high, subsiding with the fall
which occurred on the second or third day. Occasionally epistaxis occurred about this
time. The countenance was pale; the eyes red and injected with bands of deeper colour
at the outer and inner canthi owing to the eyelids remaining constantly unclosed.
Sleeplessness was a distressing symptom, and there was often delirium at night. The
pulse frequent, 100 or more, and full at the beginning, soon became soft, compressible,
and dicrotic, and eventually running, so that it was difficult or impossible to count. The
tongue was, as a rule, very characteristic. At first it was tooth-indented, somewhat
swollen, and evenly covered with a thin white fur, except at the tip and edges, where
it was clean. Later, it became dry, thickly covered with a yellowish white or brownish-
white fur, the tip and edges remaining red and irritable. The bowels were Almost
always constipated at first, but sometimes diarrhoea was present.
Buboes were met with in over three-fourths of the cases, and in about half the
number of cases in which buboes were found, the glands of the vertical set in the groin
were involved. They were as a rule noticed at the onset of the disease, giving rise to
lancinating pain, but in a number of cases were not found until the second or third day.
Generally one gland was markedly affected, and two or more adjacent ones less so. The
affected glands varied in size from that of a filbert to a walnut, and they were very tender
from the first, although often but little swollen. When in the groin the patient kept the
thigh well flexed on the abdomen in order to relieve tension. In about two-thirds of the
remaining cases the axillary glands were found to be affected, the patient usually lying on
his back with the arm held away from the side and kept perfectly still. In the remaining
third the glands below the angle of the jaw or of the superficial cervical set were enlarged.
As a rule a bubo appeared only in one region, but sometimes they were found in more
than one region, or on both sides of the body. As the disease progressed, the glands of
the same chain, situated above those first affected, often became enlarged; So that in cases
of a femoral bubo the glands lying along the course of the external iliac and common
iliac vessel were also found to be enlarged and tender on pressure. A rise in temperature
occurred with each fresh gland or group of glands involved.
In cases which proved fatal early, the buboes continued hard and very tender to the
last ; while in inoro prolonged cases effusion, frequently large in amount, occurred around
them, giving rise, to a doughy or brawny swelling, and often causing ædema of the limb below
from pressure on the vessels and nerves. [In some of these cases with axillary buboes, this
ædema would occupy the whole of the side of the thorax, occasionally reaching even as far
as the haunch-bone. The prognosis in these cases is unusually grave.—W. B. B.]
With the appearance of effusion the buboes usually became less painful. In a few
cases where the patient lived long enough, the swelling subsided by resolution, but in the
majority of instances suppuration occurred after the seventh or eighth day, the skin over
the infiltrated area becoming inflamed. On opening the bubo thin yellowish or savious
pus was evacuated ; the skin frequently sloughed eventually, however, leaving an indolent
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