270
as typical. It is high at the beginning and sinks slowly down, with frequent morning remissions. It may last as long as ten days. After this primary fever a secondary fever occurs in a majority of recovering cases. This is the "fever of absorption" and may lead to weeks of exhausting illness, and cases may die at this stage which were saved in the bottle of infection. This fever is very irregular in duration and height varying according to the extent of destruction and re-absorp- tion of the affected glands.
(g) The skin is in all cases dry and hot. In some cases cold perspiration occurs just before death. There was never anything like a critical or lytic sweat observed. Petechiae of the body were only seen in two cases. Herpes occurred in a few cases also. Four so-called carbuncles were seen. Wounds of the skin were rare and never irritated, no lymphan-
gitis being present.
(h) Nervous symptoms are caused by the fever and the overloading of the blood with infectious materials. There is generally tremor, deafness, unconsciousness, delirium, in some cases of a violent character.
(i) The heart's action was always weakened, and in many cases dilatation of the right side occurred. Systolic mur- murs and other signs of weakness being apparent.
(k) The urine always showed the presence of albumen-the average being from 1 to 5 % of albumen. In the begin- Ling retention of urine was frequent. The kidneys were congested, the capsules often showing hemorrhages. Abscess of the kidney was never seen, neither was abscess of the liver. The gall-bladder was usually distended.
(1) The spleen was usually swollen and congested the malpighian corpuscles being prominent on the surface of a section.
(m) Having considered the general symptoms of Plague we now have to deal with the most prominent characteristic of Plague, namely, the swollen glands. These may either be superficial and palpable, or intestinal and internal, or a combination of both. The affection of the glands might be called Polyadenitis, Hemorrhagica Infiltrative, a multiple inflammation of the glands with hœmorrhagic infiltration of the glandular tissue, with a tendency to infiltrative periade- nitis, spreading from one gland to another centripetally and forming chains of infiltrated glands. Some of the glands break down. Infiltration may develop very quickly-even in a few hours--and may produce an extensive cellulitis in some cases. The time of development of palpable adenitis is irregular; it may be marked and evident in the first hours of the disease. Even large buboes may form in a few hours after a time when a person has felt absolutely in the best of health. On the other hand we frequently see a patient dying of plague without one being able to feel a single affected gland and only a thorough post mortem examination shows the slightly swollen glands, of lentil, pea or almond size, which show the plague bacillus by microscope and culture-tube. The plague gland in the Polyadenitis form is clinically in many cases indistinguishable from the gland of syphilis, scrofula and lymphadenitis of ordinary septic origin. In many cases the plague gland shows a boggy, gummatous fluctuation, very tender on pressure and complicated with a hemorrhagic suffusion of the skin over it. Out of 150 cases admitted alive into Hospital the following table shows the loculisation of the glandular swelling at the onset of the disease. There were 80 males, 22 females, and 48 children.
Unilateral Inguino-Femoral, Bilateral Inguino-Femoral,
Unilateral Axillary,
Bilateral
Unilateral Cervical,..
Bilateral
27
Submaxillary Unilateral,
Bilateral,
Cubital Unilateral,
Multiple Buboes,..
48 %
9
6%
.13 = 8.5 %
.11
=
9%
2
1.3%
3 2%
0
=
0%
1
= 7.5%
4=
2.7%
33 cases (22%) were received without a proper bubo. In most of these cases multiple adenitis was found, the general size of the glands being that of a lentil. In the later stages of the disease other buboes formed in different localities and complicated the case. 90% of the cases showed swelling of the intestinal, bronchial and mediastinal glands in different stages.
(n) The mortality of patients admitted alive into Hospital was 80 %. The general mortality must be much greater, as most of the bad cases die before being discovered or in course of transference to Hospital. 76 % died during the first 6 days, 4% died later on from the 7th to the 19th day. One may say that the former died from the severity of the disease itself, the latter from the after-effects, namely, exhaustion and suppuration. Death was generally caused by paralysis of the heart, in other cases from the brain mischief. The temperature at death is sometimes very high, sometimes subnormal. Convalescence is generally prolonged and often complicated by suppurative fever.
IL-MICROSCOPICAL AND BACTERIOLOGICAL EXAMINATION,
Microscopical and bacteriological examination has been very much handicapped by the absence of a large amount of apparatus which is quite indispensable for full investigation in this branch of science, and most of the apparatus had to be supplied privately. The work can therefore be regarded as incomplete till more apparatus arrives from Europe. I can only give a few facts which already seem to be very promising for future work..
No comments yet.
Private notes are available after approval.