A very notable and the fatal form of the plague is that in which haemorrhages from the lungs, stomach, bowels, nose, &c., occur. These are of the worst omen, and are seen in some cases where there are no buboes, and which are rapidly fatal. This was observed in Irak in recent epidemics, in the outbreak on the Volga in 1878-79, and in the plague of India. It was a noticeable symptom in the black death, and was observed even in the plague of the 6th century. The bleeding is mostly from the lungs, and is sometimes associated with other symptoms of lung affection. This form of the disease appears, however, to have no distinct historical or geographical limit. A similar haemorrhagic from has been observed in small-pox and scarlet fever, and is always extremely fatal.

In all plague epidemics cases occur in which death takes place very rapidly, even within twenty-four hours, without the development of the special symptoms of the disease. Such cases are reported by Diemerbroek, Hodges, and others in the 17th century century, and the have been observed in recent epidemics in Irak, as well as in the recent plague on the Volga. Some are more like cases of poisoning than of infection, and much resemble the instances of death from the exhalations of dead bodies (cadaveric poisoning which are met with from time to time. It is these which have been rise to the expression fulminant plague. The nature of the soil has little influence on plague. It may flourish in alluvial deltas, on calcareous ridges or granitic mountains. Moisture in the soil has generally been though to be an important factor in its production, but, though often found in marsh situations, such as the banks of the Nile, the Euphrates or even the Volga, it also occurs in India at elevations approaching 7000 feet, and in Kurdistan at 5000 to 6000 feet above the sea.

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