?86	Previous history of plague in India.	[ CHAP. IV.
thirst. Eyes commonly heavy and hazy; often bloodshot. Counte-
nance in all the severer cases expressive of much anxiety and suffer-
ing. Respiration generally easy, excepting in patients having
inflammation of the lungs as the prominent feature of their malady.
"Buboes appear in the groins, armpits and neck (usually on the
left side), sometimes almost simultaneously with the fever, but
more commonly in the course of the first or second day-rarely so
late as the third or fourth. They are at first of small size, moveable,
and always acutely painful to the touch. In some few cases they
increase rapidly in bulk, suppurate, and discharge pus alone, or
mixed with shreds of dead cellular membrane. In by far the
greater number of instances, however, they do not become larger
than a walnut, and show no disposition to suppurate. The groins
are the situations in which the buboes appear most frequently.
"Sometimes there is one in each groin, sometimes in one groin
and one axilla, sometimes in one or both axilla and neck, in one or
both groins and neck, or in the neck alone. Suppuration and even
rapid increase of size without suppuration have been remarked by
the Pali people to be favourable symptoms. In persons who recover
from the disease, the buboes most frequently disappear gradually of
their own accord. I saw one man, however, in whom a bubo, in the
left groin, had attained a great size, and was likely to prove very
troublesome. It extended from the pubis to near the anterior sup-
erior spinous process of the ilium, and was hard and painful. In
this patient the fever had ceased four days before I saw him. In this
disease a remission of the febrile symptoms, more or less marked,
takes place towards morning, the remission being of longer or shorter
duration according to the mildness or severity of the malady in each
individual case. In the worst cases there is no perceptible remission.
In some the disease was so mild that the patients walked without
assistance from their houses to the place where I was standing, had
their buboes, pulses, etc., examined, swallowed their medicine and
walked home again. In others, again, syncope followed any attempt
to raise them from their charpoys. The head is but rarely affected
in the early stages of the disease. Most of the persons I saw
answered questions readily and distinctly. In fatal cases the patients
become comatose some hours before death.
"In a small proportion of cases inflammation of the lungs comes
on, on the first or second day of the disease. The patient complains
of acute pain of one or other side or behind the sternum; great
difficulty of breathing; short dry cough; usually on the second or
third day a small quantity (rarely more than half an ounce) of florid
blood, in small coagula, is expectorated. In such cases buboes are