The glandular plague, like the small-pox, is an erup- tive fever, and is the most virulent and most contagious disease with which we are acquainted. The eruption consists of buboes, carbuncles, and petechia1. Buboes are inflamed and swollen glands; and the glands so af- fected are generally those of the groin, axilla, neck, and the parotid glands. More frequently there are two, VIII.— R
three, or even four such tumors. They sometimes sub- side of themselves; or, what is more commonly the case, they suppurate: and as this process seldom" com- mences before the disease has taken a favorable turn, it is regarded as the cause, but more correctly as a sign, of approaching recovery. A carbuncle is an inflamma- tion of the skin, giving rise to a hard tumor, with pus- tules or vesicles upon it. It resembles a common boil, but differs from it in this important respect. The car- buncle becomes gangrenous throughout its whole ex- tent, so that when the eschar separates a large deep ulcer is left. Under the term petechias are included evanescent spots and streaks of various hues, from a pale blue to a deep purple, which give a marbled ap- pearance to the skin. When such livid streaks occur in the face, they disfigure the countenance so much that a patient can hardly be recognised by his friends. The disease varies go considerably in its symptoms and course that it. is impossible to give one description that will suit even the majority of cases. Sometimes the eruption does not appear at all, and even the general symptoms are not of such violence as to lead an ignorant person to suspect the least danger. The patient is sud- denly attacked with a loss of strength, a sense of confu- sion, weight in the head, oppression at the heart, and extreme dejection of spirits. Such cases sometimes terminate fatally within twenty-four hours, and occa- sionally on the second or third day. Generally, how- ever, the patient is attacked with shivering or coldness, which is soon followed by fever, giddiness, pain in the head, occasionally also by vomiting. Buboes and car- buncles in most cases make their appearance on the first day; and successive eruptions of them are not unusually observed during the course of the disease. There is a peculiar and characteristic muddiness of the eye, which has been described by Dr. Russell as a muddiness and lustre strangely blended together. The fever remits every morning, and increases during the day and night. The vomiting then increases; the tumors become pain- ful; and the patient wanders, and is inclined to stupor. On the morning of the third day, in favorable cases, a sweat breaks out, which produces great relief, and some- times even proves critical. The exacerbation on the fourth day is more severe than on the preceding ones, and continues intense until it is terminated by the sweat on the morning of the fifth day, which leaves the pa- tient weak, but in every respect relieved. After this the exacerbations become slighter and slighter; and the bu- boes, advancing favorably to suppuration, little or no fe- ver remains after the beginning of the second week. In other cases, again, t lie symptoms are tar more urgent. Besides vomiting, giddiness, and headache, there is also diarrhoea at the outbreak of the fever. During the night the patient becomes delirious or comatose. The pulse is full and strong; and though the tongue is not dry, the thirst is excessive. The fever abates some- what on the succeeding morning, but the pulse is fre- quent, the skin hot and dry, and the patient dejected. As the second day advances, the vomiting and diar- rhoea become urgent, the eyes are muddy, the expression of countenance confused, the pulse quick, and sometimes low and fluttering, external heat moderately feverish, or occasionally intense in irregular flushings. There is pain at the heart, burning pain at the pit of the stom- ach, and incessant restlessness. When to these symp- toms are joined faltering of the tongue or loss of speech, and the surface of the body becomes cold or covered with clammy sweats, death is inevitable, although it may still be at some distance. When the patient lias been much weakened by the vomiting, diarrhoea, or hemorrhage, the third day proves fatal; but more com- monly the disease is prolonged two or three days longer. In this form of plague buboes appear on the second or third day, and sometimes later; but whether they ad- vance towards suppuration or not, they seem to have no effect in hastening or retarding the termination of the disease. Lastly, in some cases, the eruption of bu-
PLAGUES
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PLAGUES
boes and carbuncles constitute the principal symptoms of the diw ase; and patients are so little indisposed that they are able to go aboul the streets, or attend to their usual, avocations, ifnol prevented by the inflammation of inguinal tumors. The disease has never been suc- cessfully treated, i xcepl in isolated cases, or when the epidemic has Beemed to have worn itself out Deple- tion and stimulants have been tried, as with cholera, and stimulants with far better ri suits.
See Llldecke, Beschreib. des tiirk Reichs, p. 62 sq.; Olivier, Voyage, vol. i, c. 18 ; Sonnini, Reist nach Grie- - sq.; Descript. <l< VEgypte, xiii, 81 sq. ; Bulard de Mern, De la Pestt Orient. (Paris, 1839); L'Aubert, Di la Peste,ou Typhus (ibid. 1840); Russell, Nat. Hist, of Aleppo ; Clot-Bey, De la Pesh en EgypU (1840), and Apercu general sur VEgypte, ii. 848 350. s. e Mi mi im .