76
[CHAP. II.
patelles were noticed in some cases at the sides of the abdomen, or thorax and over the loins,
where they were in no way due to pressure or irritation; but more frequently they occurred on
the extremities, being situated on the dorsum of the foot or hand, on the leg, thigh on forearm.
Sometimes extensive sloughing occurred, laying bare the muscles over considerable areas,
and giving rise to severe hæmorrhage. Rarely boils were seen, which became black, owing
apparently to capillary hæmorrhage : but no true carbuncles were observed.
Amongst natives the progress of the disease was towards death in about 70 per cent. of
the cases admitted into the Arthur Road and Parel Hospitals ; among Europeans and Eura-
sians treated in St. George's Hospital the mortality was less, viz., 32 . 35 per cent, and 42 . 62
per cent. respectively. As death approached, respiration became more and more shallow
and feeble, the eyes became sunken, and the patient passed from a state of muttering deli-
rium into coma, and died, as a rule, quite quietly from heart failure.
Sometimes the temperature ran up to 107° F. or more before death, and continued to
rise after death ; but more frequently death appeared to occur from collapse, the temperature
falling and the pulse increasing in frequency to such an extent that it could not be counted.
In cases that recovered the temperature generally fell by lysis on the fifth, sixth and seventh
days. But not infrequently a fall by crisis occurred on one of these days (vide Charts II,
VIII, XXII), and the patient remained in a more or less collapsed condition with subnormal
temperature, profuse perspiration and an exceedingly feeble pulse for days. In this condition
the slightest effort sometimes gave rise to fatal syncope. In the Parel Hospital 22 conva-
lescents, out of 304 cases treated there by Captain Thomson, dropped dead through attempting
to get out of bed or to sit up.
When the patient was recovering, it was occasionally found that he was suffering from
dumbness or from partial laryngeal paralysis ; or that hemiplegia, paraplegia involving the
legs or the legs and arms, monoplegia of a limb or a portion of a limb was present. In some
cases facial paralysis was observed, or paralysis of one or more ocular muscles. More rarely
the inco-ordination of the tongue, hands, arms or legs, noticed at the beginning of the attack,
remained present during convalescence, and the speech continued slow, thick, and indistinct.
(A reference ίο the case of Kallian Vishram has been omitted here.—J. K. C.)
Occasionally an attack of plague ran a very mild course, the patient (frequently a boy
of ten or twelve years) not being confined to bed by it. In these cases enlargement and
tenderness of a lymphatic gland was noticed, followed by fever (vide Chart XXVI), headache,
a characteristic tongue and sometimes nausea and vomiting ; the temperature rarely exceeded
103° F. or 104° F., and generally fell to normal or subnormal on second or third day.
Prostration and cerebral symptoms were not well marked, and the bubo subsided as a rule
without suppurating. The duration of the attack seldom exceeded three or four days, and
convalescence was established in a week or ten days.
There remain to be described two forms of the disease in which the general features of
plague in its most acute form were present, but in which there was no particular enlargement
of lymphatic glands (buboes) during life, and in which, after death, only very slight general
enlargement and congestion of the glands were found.
In one of these forms of plague the microbe grows in the blood, hence it has been called
septiccemic plague: in the other it grows in the lungs giving rise to primary plague-pneumonia.
In septiccemic plague the invasion was usually marked by a prolonged and severe rigor,
or repeated rigors ; and vomiting, headache and high fever were constantly present. The
most distinctive features of this form of the disease were the great nervous prostration
und muscular weakness present from the beginning, and the rapidity with which cerebral