Plague - Duration. Mortality. Morbid Anatomy. Pathology of Plague.
Plague - Duration
The duration of an attack of plague may be from some hours to a month. Three-fifths of the cases observed by Mr Covill were fatal on the third day, and the majority of cases in India had the same termination (Francis). Five-sixths of fatal cases end of the fifth day. Most of those who survive the fifth day get well ; after the seventh day a patient in Baghdad was considered by his friends safe ; and in Mr Colvills cases only 4 per cent. of fatal cases died after the tenth day. In non-fatal cases with suppurating buboes the disease may be protracted to two or three weeks or a month.
Plague - Mortality
Plague is the most fatal of all known disease which affect large numbers of people. The moratality to official registers in Baghdad, was 55·7 per cent. of those attacked. Dr Cabiadis thinks this too high, owing to many cases of recovery not being reported. But in some epidemics the proportion of fatal cases is much higher. In Vetlanka it was about 90 per cent., and some other villages on the Volga every person who took the disease died. The older accounts do not give the proportion of death and attacks
Plague - Morbid Anatomy
Examination after death have not done much to elucidate the nature of plague, except negatively. The appearances are those of death from an acute infective disease, and resemble those of typhus, except for the special affection of the lymphatic glands. The brain and the lungs are found to contain excess of blood; coloured and undergoing rapid decomposition. [Footnote 160-1] The spleen is found enlarged, and in a less degree the liver. The stomach and intestinal canal often show signs of inflammation and haemorrhage, sometimes ulceration. The characteristic swelling of the lymphatic glands, both external and internal, is often accomplished by inflammation of the cellular tissue around. Petechial patches are sometimes found on the internal organs.[Footnote 160-2]
Pathology of Plague.
All that is known of plague goes to show that it is a specific febrile diseases depending on the reception into the body of a specific organic contagion, which becomes multiplied in the body of the patient. Analogy makes it very probable that this contagion is a living organism of the class Bacteria, but the suspected organism has not yet discovered. The nearest ally of plague is typhus fever, so that some authorities have spoken of it as the typhus of hot climates, modified by temperature, &c., but this opinion does not appear to have ever been held by any physician who has examined the disease at first hand. It appears to be as distinct from typhus as this is from enteric fever, or other so-called typhoid disease. It has also been though that plague is related to intermittent or remittent malarious fevers; but the most recent observations show that there is no real connexion between these diseases. In India, says Dr Francis, neither intermission nor remission has. Ever been observed in plague. It is quite distinct from and in no way modified by the types of fever that are caused by malaria. Dr Cabiadis speaks to the same effect of plague in Irak [Iraq], and insists that the physical conditions which favour the production of marsh poison are not necessarily favourable to plague.
160-1 This post-mortem decomposition of the blood is doubtless the cause of some appearances described with great particularly in the older account.
160-2 Our knowledge of the morbid anatomy of plague is derived almost entirely from the observation of the French physician in Egypt during the epidemic in 1835-36. Earlier observations are of no value, and in later epidemics of Irak [Iraq] and Russia none have been made. In India Drs Pearson and Francis made a few autopsies. Clot-Bey, De la Peste en Égypte, Paris, 1840 ; Bulard, De la Peste Orientale, Paris. 1839 ; Francis, Indian Annals of Medical Science, vol. i.,1854.
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