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be a horny cleft down the centre. Vomiting may set in, or a distressing
nausea take its place. Costiveness may give way to looseness with black and
offensive evacuations, sometimes mixed with blood and passed involuntarily without
pain. The hæmorrhage, no doubt arising from the mucous surface of the bowel
tends to increase a fatal result, or there may be a fatal and persistent hiccough
accompanied by extensive tympanitis. Death is usually sudden through heart failure,
and frequently this occurs when the patient has not progressed to any alarming
degree of apparent danger. At the end of three to five days, if the skin become
moistened and the cerebral symptoms abate, the pupils begin to contract, the pulse
become slower, and a fall of temperature occur by defervescence, the prognosis has
a favourable inclination.
Meanwhile the bubo, which forms a prominent character in the disease, has
become more enlarged, tense, hardened, painful, of an obtuse kind. The integu-
mental covering may be in no way discolored, the swelling is visible and is round or
oval, and immovable. It is when signs of suppuration are setting in that the discolor-
ation is more palpable. Complete suppuration occurs in from 10 to 15 days under
favourable circumstances when encouraged to do so by the constant application of
hot poultices, or the bubo may resolve itself by gradual dispersement and absorp-
tion, or become indurated.
Highest temperature registered in the bubonic form was 107.6.
In Plague pneumonic the invasion is characterised more or less in a manner
similar to the bubonic variety, but there is no external bubo present. A slight cough
with a small patch of crepitation is soon detected, or the crepitation may occupy
distant spots in one or both lungs, usually beginning behind, and higher up than in
the ordinary form of pneumonia. The temperature may be comparatively low at
first, and there may not be much difficulty in breathing, or any dyspnœa present,
and consequently the difference between the pulse and respiration is not so marked.
The temperature rapidly ascends as the pneumonic aspect increases, and there is not
the usual sputum of rust-coloured mucus. It has more the appearance of a broncho-
pneumonic type, or a sero-mucous fluid, which, when blood-stained, is more liquid
und of a lighter colour. This blood seems almost incapable of coagulation. The
cough is not troublesome, and if the expectoration exists in quantity, there is a want
of effort to expectorate. Exhaustion is more rapid in this form of the disease. Be-
tween the pneumonic patches the physical signs may be of a normal character, or of
an interlobular form of emphysema occupying the spaces.
Highest temperature registered in this variety, 110.8.
As a rule, if the internal organs have been healthy before the person became
infected, there is at most only a slight perceptible enlargement of the liver, and
perhaps not of the spleen ; both being due to engorgement. The size of the heart
has not increased, there are no abnormal sounds or bruits, but the natural sounds
become muffled. The clear ring of the systole and diastole are obscure.
The urine shows little alteration in its specific gravity. It invariably contains
traces of albumen, occasionally hyaline casts, and sometimes red blood corpuscles,
or oven blood. The nervous phenomena arc those usually found in septicæmia,
and are in proportion to the rapidity and amount of prostration present.
Petæchiæ have been seldom observed, external hæmorrhagic extravasations
less so.
In two cases hæmiplegia follows as a sequence to the disease, but in both
instances there was rheumatic arthritis in evidence.