It is difficult to differentiate a case of true plague in its early
stages from a case of fever with benign glandular swellings or mumps.
The premonitory symptoms of plague, and even the early symptoms of the
first stage, may be due to many different diseases and therefore great
caution is needed. It is needless to say how important it is that such
diagnosis should be done with great care, specially when plague cases
have to be isolated, for if a case of simple fever with benign
lymphadenitis be brought in close contact with patients suffering from
true plague, it is a serious matter with the former. A venereal bubo, or
scrofulous enlargement of glands, or enlargement of femoral or inguinal
gland due to traumatic or other causes which may be attended with fever
should not be mistaken for a plague symptom. A medical man who has,
however, carefully observed the facies of a few cases of true plague,
and who carefully takes into consideration all other probable conditions
which may be mistaken for plague, may not commit a mistake, but its
probabilities are to be borne in mind. The practical lesson is, that all
doubtful cases should be isolated and kept separate from cases of
pronounced type. The plague bears some resemblance to typhus. Murchison
says: “Plague is perhaps the typhus of warm climates, the two diseases
being generated from similar causes and differing only in intensity from
the effects of climate and other collateral circumstances.” In typhus
there is a characteristic rush, and in plague there is bubo, but this
order of things have been found in some instances to have changed, there
being eruption in plague and bubo in typhus. The two diseases are,
however, different and bacteriological and clinical evidence corroborate
this view. Cantlie adds another disease, which he says he mistook for
plague:—“On June 26th, 1894, when the plague was at its height, I saw a
Parsee patient dwelling in a house in which plague existed, suffering
from fever 104°(F.), dry tongue, headache, backache and large swollen
glands in the left groin, which had suddenly appeared. Plague seemed the
only diagnosis, and the man, much against his will, was sent to the
plague hospital. In two days he came back again quite well, and on
examining him I found his urine thick and milky. That night I found
filaria in the man’s blood, and knew I had made a mistake in the first
instance. Of course, the mistake is most likely to happen, but
nevertheless it is not pleasant to think that we had subjected the man
to the terrible danger of plague infection.”
_PROGNOSIS._
Public-domain text, read in full here on John Shaqi.
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