being taken of their treatment, and yet terminating favorably. It is the benign plague of authors, which is observed when the disease commences and when it is at its end, though it is rarely seen in the middle period, which is entirely devastating, but it is not less plague, and it no less merits the attention of physicians and magistrates."
In pestis major there is a prodromal stage, accompanied by aching in the limbs, shivering, and a high degree of nervousness. The patient seems to be unable to quickly comprehend questions. There is a staggering gait similar to that of alcoholic intoxication. There is intense headache, with thirst and great pain in the epigastrium. The eyes become red; the tongue dry, swollen, fissured, and sometimes black, and at other times covered with a thick white coat. Coma may set in and death result before there is any marked elevation of temperature. In some cases, however, the temperature may reach 107° F. during the twenty-four hours preceding death.
In the cases less rapidly fatal there are glandular swellings. These occur in the groin in about fifty per cent of the cases, in the armpits in about thirty-five per cent, and less frequently in the neck and other localities. One peculiarity of the graver form of the disease is the occurrence of stablike pains in various portions of the body. This symptom gives rise to the superstition among the ignorant that the victim is wounded by invisible arrows shot from the bow of some demon. Suppuration of the buboes with free discharge has been regarded as a favorable symptom. The skin is sometimes covered with livid petechiæ, which become very dark after death. This condition gave rise to the term black death, which has been applied to certain epidemics. Large carbuncles may form in various parts of the body, and these are regarded as a very unfavorable sign.
A highly fatal form of the disease is accompanied by hæmorrhages from the lungs. This was a noticeable feature of the pandemic of the sixteenth century, and it was also observed in the recent outbreak along the Volga. Such hæmorrhages indicate a grave form of intoxication, and have been observed in the severer forms of other acute infectious diseases, such as smallpox.
The virulent form of the plague is often very rapid in its action, sometimes destroying life in a few hours, but the majority of fatal cases terminate about the fifth day. During an epidemic at Bagdad it was said that those who lived until the seventh day were safe, but, according to Colvill, four per cent of the fatal cases terminated after the tenth day.
The mortality from the plague in its virulent form is probably as great as or greater than any other of the acute infectious diseases. In many epidemics it may be more than ninety per cent.
