PLAGUE 173 



Onset.— Sudden, temperature on third day rises to i03°-i04° F., and 

 falls on the sixth or seventh day (remember pneumonia). Pulse 130, 

 respirations 30-45. Marked prostration, vomiting, diarrhoea, general 

 bodv pains, rigor and staggering gait. In a few hours after the onset 

 eyes become bloodshot, nostrils dilated, and temperature very irregular; 

 if recovery it may fall by lysis, or if no recovery it falls rapidly to sub- 

 normal, and rises rapidly to 107° F., and death supervenes. Thirst is 

 marked. Tongue furred at first, later sordes on tongue, teeth, and 

 lips. 



Abdomen not tender imless there are enlarged abdominal glands. 



Spleen always enlarged. Liver often. 



Cardiac dilatation important. 



Pulse may rise to 180 and become thready. 



Coagulation of blood diminished. Bacilli can be grown from the 

 blood in manv of the cases. Red cells and lib. increased, leuco- 



Inguinal plague bubo. (From Prolessor Simpson's collection.) 



cytosis is marked 90,000 — 100,000, but leucopa^nia mav ensue in 

 septicemic foi'ms. 



Breathing rapid, B.S. harsh with moist rales, signs of lobar 

 pneumonia may occur, sputum is then ha?morrhagic and full of bacilli. 



Buboes, seen in groin, axillae and neck, are painful. The legs mav 

 be drawn up, or the head bent over because of them, when seen in the 

 first twenty-four hours. These glands may resolve or suppurate. 



Skin hot and dry, with vesicles, pustules, necrotic areas, petechia,, 

 ecchymosis, epistaxis, hc-ematemesis, mal^ena, haematuria. 



Urine diminished. Specific gravity high; bacilli may be found. 



Anuria usually before death. 



Pregnant women alM^ays abort. 



Weakness, wild delirium, coma, death third to fifth dav. 



If recovery, temperature resolves by lysis, pulse rate is diminished 

 and convalescence begins. Death may still ensue from cardiac failure, 

 suppuration, septic infection, or secondary haemorrhage. 



