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"in size they vary from that of an almond to that of an
"orange. Later on they may 'gather' and burst like
"an ordinary abscess. There may, too, appear about
"the body purple spots, and what are known as
"' carbuncles.'
"But buboes are not an essential feature of plague.
"Cases occur in which these manifestations of the
"disease are greatly delayed or even absent, as for
"instance in ' Pneumonic,' 'Gastric,' and 'Septicajmic'
"plague; forms of the malady which may be mistaken
"for respectively inflammation of the lungs, typhoid fever,
"and acute blood poisoning. Plague in these forms is
"always grave; not only because of the fatality of the
"cases, but for the reason that they, especially the
"'pneumonic,' are highly infectious to other persons.
"It is important, therefore, that in localities where
"plague is present or is threatened, cases of anomalous
"illness of the above sorts be, without loss of time,
" brought under medical supervision.
"Besides the forms of plague already referred to, there
"is yet another, namely, the so-called 'ambulant' form.
"In plague of this description the affected person is
"hardly ill at all, presenting no definite symptoms
"perhaps beyond indolent, though painful, swellings in
"groin or armpit. Such plague cases may, nevertheless,
"be instrumental in spreading the disease, and any
"persons therefore who, having been possibly exposed
"to plague, exhibit these symptoms, should be isolated
"and watched medically until the nature of their
"malady has been definitely ascertained.
"W. H. POWER,
"Local Government Board, "Medical Officer.
"Medical Department,
"September, 1900."