SYMPTOMS OF PLAGUE 389 



skin, and thirst. The eyes are injected as if inflamed ; the expression, 

 at first haggard, anxious and frightened, becomes subsequently vacant, 

 listless, and dull ; the utterance is thick, and the gait unsteady as in 

 one under the influence of drink. Mental aberration develops quickly. 

 There is frequently a marked tendency to faint. The tongue is at first 

 covered with a moist white fur except at the edges, which are red, 

 but later on it becomes dry and of a mahogany colour. Vomiting and 

 nausea are present from the onset. Sleeplessness is a characteristic 

 symptom. 



The most distinctive sign of plague is the presence of swellings, 

 or " buboes " as they are called, in the groin, armpit, or neck. These 

 "buboes," which led to the disease being called "bubonic plague," 

 and which have no relation to venereal complaints, appear as a rule 

 on the second or third day of the disease. They occur as large, 

 smooth, tense swellings. They are usually painful and tender on 

 pressure, and in size they vary from that of an almond to that of 

 an orange. Later on they may " gather " and burst like an ordinary 

 abscess. There may appear about the body purple spots, and even 

 " carbuncles." 



But buboes are not an essential feature of plague. Cases occur 

 in which these manifestations of the disease are greatly delayed or 

 even absent, as, for instance, in " pneumonic," " gastric," and " septi- 

 caemic" plague; forms of the malady which may be mistaken re- 

 spectively for infiammation of the lungs, typhoid fever, or acute 

 blood poisoning. Plague in these forms is always grave ; not only 

 because of the fatality of the cases but for the reason that they, 

 especially the " pneumonic," are highly infectious to other persons. 

 It is important, therefore, that in localities where plague is present 

 or is threatened, cases of anomalous illness of the above sorts be 

 without loss of time brought under medical supervision. 



Besides the forms of plague already referred to, there is yet 

 another, namely, the so-called " ambulant form." In plague of this 

 description the affected person is hardly ill at all, presenting no definite 

 symptoms perhaps beyond indolent, though painful, swellings in 

 groin or armpit. Such plague eases may nevertheless be instrumental 

 in spreading the disease, and any persons therefore who, having 

 been possibly exposed to plague, exhibit these symptoms, should be 

 isolated and watched medically until the nature of their malady has 

 been definitely ascertained. 



The sudden onset, the marked prostration, the mental aberration, 

 the splitting headache, vomiting and nausea, backache, the rise in 

 temperature, the furred tongue, when taken in conjunction with 

 tenderness and pain in some one of the groups of glands, are sufficient 

 to arouse suspicion as to the case being one of plague. 



The distribution of plague at the present time is fortunately a 



