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Morbid Anatomy.—The four fatal cases were all examined post mortem, and all presented certain general appearances. Post mortem staining and discoloration were rapid and marked. Rigor mortis set in early. The skin, on being reflected from the bubo beneath, was found much congested: the tissues about the buboes were intensely congested and hæmorrhagic, the glands were found enlarged, and on section was of a dark red colour. In one case the glands were much enlarged, and in a foul, sloughy condition. The heart was relaxed and dilated. Broncho-pneumonia was met with in one case. The spleen was large, soft, and friable. Liver slightly enlarged, and in one case very pale. Smears from the spleen showed the bacilli in great numbers.
Treatment.—Careful and judicious stimulation with good nourishment were the lines of treatment. The condition of the heart was always carefully watched, and appropriate remedies given when circumstances required. Ichthyol with glycerine of belladonna was applied to the bubo, if painful. As soon as signs of suppuration appeared the bubo was incised.
31st March, 1903.
Appendix III.
Case I.— H.M., age 21 years, waiter. First case in 1903. Two other cases from same place. First seen on 26th January; then had been ill two days. Onset sudden; nausea; pains all over body and in right groin; headache; vomiting; speech stammering; talkative and wandering in speech; few spots on forearms; bubo developed when first examined; many fleabites on legs; no other abrasions; delirious and excited for two nights; termination by crisis; femoral bubo and inguinal bubo both suppurated. Diagnosis established by examination of smears from glands.
Case II.—N.B., age 19, living and employed at same place as Case I. Sudden onset; high temperature; vomiting and diarrhœa; left femoral bubo developed in 12 hours; eyes injected; rapid pulse and quickened respirations; active delirium, but not violent; diarrhœa persistent. Died on fifth day. Usual post mortem appearances. Diagnosis confirmed by post mortem, culture, and inoculation.
Case III.—L.B., age 23 (female), employed same as Cases I. and II. Right axillary and supra-clavicular buboes; diarrhœa persistent; rash well developed on forehead and forearms; delirium, but not very acute.
