?123
It is of interest to note that in this case the enlarged glands in the
right groin completely receded, while all those in other positions (namely,
the right and left cervical, the sub-mental, the left axillary and left
inguinal) suppurated.
CASE V.-BUBONIC PLAGUE.-MULTIPLE BUBOES; H???R??R????
DIARRHŒA;   RECOVERY.
Shivram Vithoba, Hindoo male, aged 22; admitted to hospital
March 2nd, 1898, with a history of two days' illness.
State on admission.-Temperature 102·8°, pulse 130, very feeble;
respirations 40. There is a small, hard, tender bubo in the left axilla,
and a small patch of necrosed skin on the anterior surface of the left
forearm. Between the left little and ring fingers is a small furuncle.
The tongue is moist and slightly furred. The bowels are regular.
There is no cough. The spleen is not enlarged. The mental state is
clear. At midnight the temperature rose to 105° and the patient
became delirious and restless.
Treatment.-Rest; milk diet. Three ounces of rum in the twenty-
four hours. Poultices to the bubo.
R./   Mixt. Quinine cum Strychnia oz. I, every 4 hours.
and for the hyperpyrexia:
R./ Phenacetin gr. XV, statim.
Course of the illness.-The bubo in the left axilla slowly receded.
On March 8th a small tender bubo appeared in the left groin. On
March 10th a similar bubo appeared in the right axilla, and on the 11th
a fourth bubo was noted in the right neck, below the ear. The bubo
in the left groin was incised on the 13th and discharged freely.
Those in the axillæ and neck receded without suppuration. On
the 23rd the bubo in the left axilla, which had nearly disappeared,
became larger and painful but it again receded without suppuration.
On the 24th a very tender swelling of the left supra-trochlear gland
appeared and rapidly suppurated, and was opened on the 25th. In the
meantime the temperature had been constantly high, on two or three
occasions rising above 104°, but on the whole showing a tendency to
become lower. Exceedingly troublesome diarrhœoa set in on March 4th
and lasted with intermissions until the 10th. Between the 4th and the
15th the patient was extremely weak, and the prognosis at this time
seemed almost hopeless. He was placed on special diet, with egg-flip
and an increased quantity of rum, and Strychnia and Aether was injected