It was some comfort to a mother to be allowed to watch her thin, bright-eyed child panting its life away, but the absorbed intensity of her watching, as a rule, had not to continue long. The disease begins with violent headache and a rapidly increasing temperature; the breath becomes terrible, and the tongue chalky white or bluish. There is a strong objection to taking food or drink, and milk is often spat out by a spasm in the throat, as in hydrophobia. Delirium supervenes about the third day and usually lasts to the sixth, when most patients die. During the delirium there is an extreme desire to get up and walk about, so that many patients have to be strapped down to their beds. Far the most important thing is to keep the patient absolutely still, as death most frequently comes from collapse of the heart, and recovery depends almost entirely upon the patient’s constitutional power of heart action. An English lady, who had come through the disease, told me that even during the delirium she seemed to be dimly conscious of the strain on the heart; but this memory may have been only suggestion. I think the delirious patients that I saw would be incapable of remembering anything of those three days, even if they recovered. Meantime, in their benign efforts to work off the poison in the blood, the glands have from a very early stage developed into hard lumps that usually suppurate and have to be incised, but sometimes absorb without operation. When I touched the glands in the groin, they felt like walnuts under the skin, and it is, as I said, the presence of this obvious symptom which gives the plague its characteristic name of “bubonic,” from the Greek word for groin. After incision, the patient’s temperature often goes down rapidly, but, in any case, the pain from the glands is usually very great; indeed, I think it is the chief cause of such pain as the plague gives. Next to heart failure, the commonest cause of death is lung complication after the crisis of fever is passed. The prostration when the temperature begins to decline is usually extreme, and some patients whom I saw were so emaciated that they appeared to be parodies of famine—legs and arms like sticks, back and ribs like frameworks of bone. It is true that probably they were not very fat when they went into hospital. The delirium often leaves the patients silly, and if I had been in Central Africa again, I should have said at once that several of them had sleeping sickness in the third or fourth month—the time when, in sleeping sickness, the control over the emotions begins to fail. The nurses in the hospital were Indian women, under the direction of a European Sister.[13]