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Reviewing opinions generally, the following is a rational classification of forms
of Plague :-
1. With enlarged glands (gravity according to symptoms and severity of attack) ...
Femoral.
Inguinal. Axillary. Cervical.
Tonsilar.
Septicmic.
1 Pneumonic.
2. Without enlarged glands (almost always fatal) ...
Mesenteric, enteric or
Gastro-intestinal.
Nephritic.
Cerebral.
The characters of the forms and types are due to a variation in the method of
entry into the body of the poison which is the direct source of the disease and
common to all. The forms and types may be mixed so as to produce a combination of
the characters of two or more, and each may be varied by a degree of intensity, mild,
severe, or hmorrhagic. The hmorrhagic condition is more often associated with
those types of the disease in which the glands are not enlarged, and is always most
grave as it shows great destruction of the blood constituents. The hmorrhages
may be petechi, or extravasations or exudations from the mucous tracts.
It must be carefully observed that the diagnosis of a type is not made upon
the complications which are likely to occur in all. Many cases of the form with
buboes show complications affecting the lungs or the brain ; but the type is a
definite one, and the complications are distinct from the evidences of a type.
The relative proportion in which the different types occur is fairly represented
by the following records :-
Port Trust Hospital.
About.
5 per cent
Enlargement of cervical glands ,.. ...
axillary .........
14
femoral, inguinal glands ......
48
mixed variety ........ .
2
abortive ,, .........
28 ,,
In No. 10 District :-
With enlargement of glands generally ......
...
85 per cent.
,, femoral and inguinal glands
...
60
axillary .........
...
17
Cervical .........
9 ,,
Pneumonia type
...
12
Gastro-enteric type ... ... ... ...
...
3
Signs and Symptoms.
The possibility of such a classification of plague as the foregoing shows that each
type has characteristic signs and symptoms due to the typical development of the
case, but at the same time there are certain general symptoms common to all cuses
which are due to the virus, the fountain-head of all the manifestations of the disease.
These are now well known, and with them are associated the different features of some
one or more types, so that the general symptoms are the basis of the diagnosis of the
disease, while the local or visceral conditions constitute the revelations of the type.
The onset is, as a rule, very sudden, and commences with a more or less severe
rigor, followed by a rapid rise of temperature, or there may be only a sudden rise of
temperature. The countenance has an expression of fear ; there are nausea and often