PLAGUE (BUBONIC PLAGUE).
Definition.—A virulent infectious dis ease due to a specific organism, charac terized by the formation of one or more buboes or by the development of a vio lent form of primary confluent pneu monia.
Varieties.—Two varieties of this dis ease are usually recognized: the simple bubonic, in which buboes appear in the femoral, inguinal, axillary, cervical, or tonsillar regions; and the pneumonic, in which no buboes appear on the surface, the septic process manifesting itself mainly as a of which the lungs, the mesentery, the gastro-intes tinal tract, the kidneys, and the brain are the main centres.
Reviewing the opinions expressed gen erally, the following appears to be a rational classification of the various forms of plague: 1. With enlarged glands (gravity according to symptoms and severity of attack). 2. Without en larged glands (almost always fatal).
Brigadier-General Gatacre (Report on Bubonic Plague, Bombay, '97).
Symptoms.—The disease is suddenly ushered in with a chill, the temperature rising somewhere between 101° and 105° The patient reels like a drunkard, owing to marked vertigo, and complains of violent headache and great lassitude. This sudden and early exhaustion is ap parent in the features, the drooping eye lids, the apathetic air, and the evident indifference to surroundings constituting the facies pestica characteristic of the disease. The respiration is usually rapid, the pulse also; the conjunctive are con gested, and keratitis, iritis, or panoph thalmia are sometimes observed. The tongue is swollen, shows the impression of the teeth, and is covered with a whitish fur resembling mother-of-pearl (Bulard).
In the bubonic form the bubo appears during the first hours of the malady and is usually unique. In the order of fre quency it presents itself in the groin, the axilla, or the neck. It develops with ra pidity and is well advanced as early as the beginning of the second day, and is always very sensitive to the touch almost from the start. The neighboring tissues are tumefied and cedematous, especially in the parotid region. When this locality is invaded oedema of the larynx is to be feared.
On the second day the bubo is about the size of a pigeon's egg, and there is aggravation of all the constitutional symptoms, the pulse reaching sometimes 140. Delirium now appears and the stage
of apathy is replaced by one of excite ment, during which the patient may try to get up. Psychical disorders become manifest, fixed ideas predominating. Functional disturbances of speech are also frequently observed. On the third day all the symptoms become still further aggravated, the pulse reaching 140 or beyond, and the bubo attains perhaps the size of a hen's egg, and suppurates. Occasionally it becomes gangrenous. Carbuncles may develop in different parts of the organism. Extensive petechim are usual: the "plague-spots" of older writers. Haemorrhages from mucous membranes, the nose, the lungs, etc., are frequently observed. In some epidemics haemor rhages are witnessed in all cases, the buboes assuming an hemorrhagic type.
The most frequent form of the plague is the septic-luemorrhagic, characterized by primary limmorrhagic buboes, most common in the groin, axilla, or cervical region. The surrounding tissue is fre quently markedly mdematous. There are numerous haemorrhages of variable sizes in different orgars. There is acute enlargement of the spleen (spleen-tumor).
Various lymph-organs, the lymphatic glands, and follicles of the intestine, mouth, and also of the tonsils are more or less involved. Commission for the Study of Plague, Imperial Academy of Sciences of Vienna (Wiener klin. Woch., Mar. 20, '97).
Death, in the majority of fatal cases, generally occurs about the fourth day, either from toxic paralysis of the respira tory or cardiac centres or from collapse. If the first four or five days—the acute stage—are passed safely, the chances of recovery are favorable. On the other hand, a stage of marasmus or profound depression may appear on the fifth day and the patient succumb on the sixth. Much depends upon the condition of the heart. Some cases, especially in children, are very benign, showing but an insig nificant rise in temperature, slight guinal or axillary pain, general depres sion, and ephemeral torpor. Such cases, however, are apt to occur early in the course of an epidemic. On the whole, the disease shows a very high rate of mortality.