NON-SPORING BACILLI 267 



degrees of frost), which prevented the people going out of 

 doors. Secondly, the low, dark, dirty, and overcrowded 

 houses which form the majority of the dwellings. Never- 

 theless in Shuangcheng Fu, a finely planned city with wide 

 streets, spacious compounds, and well-constructed houses, 

 and with but little poverty, there were 1,500 deaths in 

 seven weeks out of 60,000 inhabitants. 



Symptoms. The incubation period in the majority of 

 cases was five days. There were no marked prodromal 

 symptoms. Often a man had a normal pulse and 

 temperature on one day and was dead the next. The 

 invasion was without rigor, with feelings of illness, weak- 

 ness, and giddiness. A sudden onset with headache, then 

 bloated face and suffused conjunctivae (septicaemic cyanosis), 

 with temperature over 103 F., and fast fluttering pulse, 

 was usual. The respirations averaged thirty-five per 

 minute. Coarse crepitant rales were noted all over the 

 chest, but little or no impairment of resonance. These 

 rales are due to marked oedema of the lungs in the late 

 stages of the disease. In the earlier stages rales are rarely 

 present even in serious cases, and then they are usually 

 fine. Blood-stained sputum is often the first sign of 

 illness in pneumonic cases. The signs of cardiac involve- 

 ment are always marked in advanced cases : very rapid 

 feeble running pulse, agonizing dyspnoea, galloping rhythm 

 of the heart sounds, and sudden heart failure. Death 

 occurs from the intoxication, with paralysis of the heart. 

 Death resulted in attempts to move patients and where 

 the patients sat up in bed for a few minutes to take nourish- 

 ment. Labial herpes was not observed in any of the 

 patients seen in hospital, which is a point noted before 

 and interesting in comparison with acute lobar pneumonia, 

 in which it frequently occurs. In the septicaemic form 

 there may be a flow of blood from the nose or mouth 

 shortly before death. No glandular enlargements were 

 noted except once at Harbin, where there was a sub- 

 maxillary bubo followed by secondary plague pneumonia 

 and death. The bacteriological diagnosis was the only 

 certain one, as the symptoms were so variable. Many 

 were able to walk about until within a few hours of death, 

 and up to that time declaring that they were quite well. 



