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Chapter   III.
The Medical Aspect of Plague.
The medical officers working under the Committee both at the Government
and Private hospitals were directed to submit their views regarding some of the most
salient features of Plague, and the following interesting results of their investigations
and observations are recorded. The forms and types of Plague are distinguished by
some into simple bubonic and pneumonic plague only, by others as plague (with buboes
and without buboes) ; all the variations on these two forms being grouped under
symptomatic evidences of complications, associated with one or other form. Another
variety is included by several writers under the names of the gastro-intestinal-
mesenteric, enteric, or abdominal form, and there is a tendency to indicate a fourth
variety with marked brain symptoms as a cerebral type, and a fifth or nephritic form.
Some few very rare cases occurred in which carbuncles were the prominent symptom.
In the bubonic form the disease is characterised by the development of glandular
swellings in some one of the gland areas, the femoral, the inguinal, the axillary, or the
cervical regions, and each may again be classified as a mild or severe form of the type.
The mild form was sometimes unaccompanied with marked febrile symptoms. Certain
such cases may be described as an abortive form of Plague, and are characterised by
the formation of buboes, fever of a low type, and slight constitutional disturbance.
They terminate in recovery in about 10 days. The proportion of the types seemed to
vary with the progress of the epidemic in the later months of its prevalence, as shown
by the following table of observations from the Cutchi Memon Hospital :-
	In the beginning.		Later.
With Buboes   ...	   Mild form without febrile symptoms ...  Mild form with febrile symptoms	2% 1 % 95%	5 % 20 % 65 %
Without Buboes..	     With lung complication        ...        ......     Without lung complication .........	1 % 1%	5 % 5 %
The table also shows that as the epidemic proceeded an increase took place in
the mild types of Plague with buboes and with or without febrile symptoms, and
also in the non-bubonic types, whilst there was a corresponding decrease in the
severe forms of the bubonic types. This result is due to an attenuation of the poison,
and a diminution of the virulence of infection by the passage of the virus through
many individuals ; also the converse may occur, and cases of the mild form undoubt-
edly occurred in the month of October 1896, in certain districts, which were followed
by a severe outbreak of the disease, Byculla being a particular instance. These mild
eases might be importations from a badly-infected region which, unless promptly
segregated, might be the means of starting a large and severe epidemic amongst an
unprotected population. A warning of this kind seems to have occurred in Calcutta, and
it is possible that the active measures taken with regard to a few mild cases in that
city, and subsequent careful inspection of ingress traffic may have prevented the disease
from gaining a foothold there.
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