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lymphatic gland in anatomical connection with the vesicle was inflamed
and tender in each of those cases, and was the only one affected as far as
could be made out.
The occurrence of boils was frequently noted as a sequela, and true
carbuncles were never met with in any of the Parel patients. An acute
necrosis of the skin, sub-cutaneous tissue, and gland occurred in three
instances, but was not of such clinical features as to arouse the idea of
carbuncle in the mind of the observers. It is to be further noted that in
every such instance the patient or his friends had applied some irritant over
the gland, usually a mixture of marking-nut, chunam and ghoor (molasses).
That carbuncles are met with in plague, one can hardly doubt; but
the experience of the Parel cases would lead one to conclude that their
appearance is not characteristic or, by any means, a diagnostic of plague.
That they were carefully looked out for at Parel with the assistance of
other investigators precludes the idea that their presence could have been
overlooked.
In some cases a peculiar earthy, cellar-like odour was detectable from
the patients' skin and breath. It is a remarkable fact that this odour
was quite familiar to the nurses, and noted independently by one of the
very intelligent nursing sisters, who thought it was confined to fatal cases.
The smell was quite distinct from that due to involuntary passing of the
motions or urine in the bed, and was observed in some cases in which the
patient had perfect control over his evacuations. Generally, cases ending
in fatal septicæmia evolved this odour from the skin and breath, but a few
patients in which its presence was unmistakeable, recovered.
The Pulse.-As a rule, the pulse is over 100 per minute, and a slow
pulse was not met with in a single case of plague. It may reach 120 to
140, or even 170, per minute during the course of the disease. Seen early
in the disease, the patient will be found to have a frequent (110 to 120),
full, bounding, soft, and compressible pulse which is markedly dicrotic
and presents a want of vehemence in the stroke. A gradual fall in the
frequency of the pulse-rate is a favorable sign, and a great rise after a
fall means some complication supervening. There does not appear to be
any definite pulse-respiration ratio, although at first both are elevated, and
finally it becomes very rapid and often imperceptible before death.
A marked character of the pulse, on which some interesting observa-
tion were made both during the fever and in convalescence, was the in-
fluence of posture on its frequency and force. The frequency became
increased by as many as 20 to 32 beats per minute, and it became
small, weak, almost thready and irregular (and all this seemed to be due
to the great prostration of the nervous system) when the patient was
helped gently and carefully to sit up. The heart's sounds were con-
stantly found to be normal, although the impulse was diffused and strong.
No murmurs were detected in any patient at Parel at any stage of the