secondary adenitis, succeeds the primary fever. The sores left by the buboes and abscesses of plague are extremely indolent, and may take months to heal.
Hœmorrhages of different kinds are not an unusual feature of plague. Ecchymotic effusions of a purplish or dull-red tint, and varying in size from a hemp-seed to spots half an inch in diameter, are very often found scattered in greater or less profusion over the skin, especially on exposed parts of the body and at the sites of insect bites or of wounds. Larger patches of cutaneous hæmorrhagic effusion are rare. There may be bleeding from the nose, mouth, lungs, stomach, bowel, or kidneys. Hæmorrhages occur with marked frequency in certain epidemics; they are regarded as evidence of great malignity. Especially malignant are those epidemics in which hæmoptysis, or pneumonia, is a common occurrence.
Abortion almost invariably occurs in pregnant women; the fœtus sometimes shows signs of the disease.
Death may take place at any time in the course of plague. Usually it occurs between the third and fifth day, with symptoms of profound adynamia, heart failure, or perhaps from convulsions, from coma, from internal hæmorrhage, or, later, from exhaustion consequent upon prolonged fever or suppuration, or from secondary hæmorrhages.
On the other hand, in a certain proportion of cases convalescence sets in and proceeds more or less rapidly. Generally it is a tedious affair, being prolonged by suppuration, sloughing, and similar complications.
The foregoing description applies more especially to the ordinary bubonic (as it is called) type of the disease. Of late, certain other forms of plague have received individual recognition in consequence of their extreme virulence and, in the case of one of these forms, of its high degree of coimnunicability. These forms are called respectively septicœmic and pneumonic.
Scpticæmic plague, sometimes called pestis siderans.— In this type there is no special enlarge-
