KEDIOAL ASPECTS OP PLAGUE.]
77
symptoms supervened. Delirium often set in during the first day, and was quickly followed by
picking at the bed clothes, stupor and coma, in which the patient died generally on the second
or third day, but sometimes within twenty-four hours of the onset. In some cases death did
not occur for several days. The pulse early became soft and very frequent, 120 to 140 or
more; the temperature (vide Chart XXV) rapidly rose to 104° F., 105° F., 106° F., ran an
irregular course and often reached 107° F. or more before death; respiration was hurried and
panting ; gastro-intestinal catarrh and tympanitis were frequently present ; the urine was often
retained. Epistaxis and sub-conjunctival hsemorrhage sometimes occurred ; blood was occa-
sionally seen in the stools and urine ; and, if the patient lived long enough, secondary
pneumonia sometimes set in. These cases were very fatal.
In a considerable number of cases primary plague-pneumonia was observed, the develop-
ment of the disease being due to the growth of plague bacilli in the lung tissue. Lobular
pneumonia was the form usually met with in these cases. Its onset was marked by rigors,
or, in some instances, by chills, followed by a sense of constriction across the chest, difficult
and hurried breathing, cough and expectoration. As the disease progressed, respiration
became very frequent (forty to sixty in the minute) and difficult, and duskiness of the face
appeared. Pain was present, but never appeared to be severe or stitch-like in character, and
was rarely much complained of. The expectoration, bronchitic at the beginning, very soon
became watery and profuse ; it often contained little whitish specks floating in it, and on
examination was found to contain plague bacilli in great numbers. Frequently this serous
expectoration was tinged of a pink or reddish colour from the presence of blood ; but rusty
sputa, as in ordinary croupous pneumonia, were rarely seen. There was great prostration
-from the first ; the pulse soon became feeble and very frequent, so that the alteration in the
pulse-respiration ratio ordinarily met with in pneumonia was not observed ; the temperature
was high and ran an irregular course (vide Charts XI, XII, XVII, XIX, XXIX, XXX,
XXXI), the tongue was coated white, except at the tip and edges, and the bowels were
confined. The physical signs present were those of broncho-pneumonia, patches of con-
solidation being found in one or both lungs, the right generally being the one most affected.
Very soon marked œdema occurred, the lungs becoming loaded with fluid. Buboes were not
met with in these cases, but slight enlargement of the lymphatic glands was sometimes
found before death. Death generally ensued in three or four days, and was preceded by
incessant cough and by blueness of the skin due to deficient aeration of blood, caused
mainly by the amount of fluid in the air vesicles.
The complications met with in plague were—in the nervous system delusions, in one
case ending in insanity ; motor paralysis, local or general ; impaired sense of touch ;
sometimes diminished sensibility to pain, sometimes hyperaasthesia ; deafness; ulcération of
the cornea, conjunctivitis, and sub-conjunctival hsemorrhage. In the circulatory system,
softening of the muscular tissue of the heart with enfeebled cardiac action and dilation of the
heart. In the respiratory system, bronchitis ; hypostatic congestion and oedema of the lungs ;
secondary pneumonia ; pleurisy ; and rarely pulmonary hæmorrhage. In the digestive
system, gastro-enteric catarrh; diarrhcea ; and in a few cases haemorrhage from the bowels.
In the urinary system, albuminuria ; renal congestion, and renal haemorrhage, in one case
causing death, In the reproductive system, menorrhagia at the menstrual period; and abor-
tion in many cases of pregnancy. In the cutaneous system, sloughing of the skin and boils.
The sequelæ most frequently met, with were deafness in one or both ears; impairment of
vision due to degeneration of the choroid and retina ; dumbness due to the loss of memory of
words, or to laryageal paralysis ; paralysis of the muscles of the eyes or face ; paresis or
20