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diff --git a/old/62931-0.txt b/old/62931-0.txt deleted file mode 100644 index 5c5a30b..0000000 --- a/old/62931-0.txt +++ /dev/null @@ -1,1677 +0,0 @@ -The Project Gutenberg EBook of The Bubonic Plague, by A. Mitra - -This eBook is for the use of anyone anywhere in the United States and most -other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms of -the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you'll have -to check the laws of the country where you are located before using this ebook. - -Title: The Bubonic Plague - -Author: A. Mitra - -Release Date: August 15, 2020 [EBook #62931] - -Language: English - -Character set encoding: UTF-8 - -*** START OF THIS PROJECT GUTENBERG EBOOK THE BUBONIC PLAGUE *** - - - - -Produced by deaurider, Stephen Hutcheson, and the Online -Distributed Proofreading Team at https://www.pgdp.net (This -file was produced from images generously made available -by The Internet Archive) - - - - - - - - - - THE BUBONIC PLAGUE. - - - BY - A. MITRA, L.R.C.P., L.R.C.S., F.C.S., - _Chief Medical Officer, Kashmir._ - - - Calcutta: - THACKER, SPINK AND CO., - 5 & 6, Government Place. - 1897. - - - - - CONTENTS. - - - Page - What is it? 1 - Its History 1 - The London Epidemic of 1865 3 - Geographical Distribution 8 - Causes 8 - Bacillus 9 - Contagious as well as Infectious 11 - Nature of an Epidemic 13 - Incubation 17 - Symptoms 17 - Varieties 21 - Diagnosis 21 - Prognosis 23 - Microscopic and Macroscopic Appearances 24 - Prevention 24 - Sanitary Measures by Municipal Authorities 26 - Private Hygiene 29 - Inoculation against Plague 32 - Treatment 33 - Treatment of Symptoms 38 - Disinfection 40 - Purification of a Room after Plague Cases 41 - - - - - THE BUBONIC PLAGUE. - - - - - _WHAT IS IT?_ - - -Any contagious and fatal epidemic disease was originally called a plague -(from _plaga_, a stroke), but this term is now applied to that -particular kind of plague which is characterised by the appearance of -high fever with inflammation of lymphatic glands or bubo, and is -therefore called the Bubonic Plague. In Sanskrit Medical Books it has -been described as _Vidradhi_ and _Visharpa_, and in Yonani as _Taoon_. -The following definition given by Cantlie is comprehensive. “Plague or -Malignant Polyadenites is an acute febrile disease of an intensely fatal -nature characterised by inflammation of the lymphatic glands, marked -cerebral and vascular disturbances, and by the presence of a specific -bacillus.” - - - - - _ITS HISTORY._ - - -It is an ancient disease mentioned in Hindoo and Christian Scriptures. -Long before the Christian era it prevailed in Greece, attacking the town -of Piræus, where it raged for two years. Egypt, Syria, Constantinople -and Rome were visited by the plague. In Constantinople the outbreak was -once so furious that during three months from 5,000 to 10,000 deaths -occurred daily. The first historical allusion to plague was made by -Rufus, a physician who lived in the reign of Trajan (A.D. 98-117), and -who mentions of glandular swellings. In 1347, plague appeared in almost -all countries in Europe, where Hecker believes, 25 millions of persons -perished. Ireland was visited by plague three hundred years after its -invasion by Patrolan, and it is said that 9,000 people died in a week -and were buried at Tallagh near Dublin—a name which means the burial -place of the plague-stricken. Plague visited England frequently, and no -fewer than eighteen epidemics are said to have occurred before the great -plague of 1665. In 1720, 40,000 out of a population of 90,000 died at -Marseilles. In 1751, 150,000 died of plague in Constantinople. In 1799 -the French Army in Syria was devastated by plague. 6,000 persons died in -Malta in 1813. In 1834-35, 14,888 persons died in Alexandria out of a -population of 42,000. In 1876 there was an outbreak of the disease at -Kumaon in Northern India, where it prevailed several times during the -present century, and where it is known as the _Maha-Mari_. It is also -said that it prevailed in 1815 on the Island of Kutch, and lasted till -1821 in Kutch and Sindh. It also occurred between the years 1828 and -1838 in Jhansi, Bareilly, Pali and Jodhpore. In China the plague has -been present for a long time in an epidemic form. In 1894 60,000 persons -died at Canton. From Canton it spread to Hongkong and to Amoy. In 1895, -it visited many places in Southern China. In 1896, it was present at -Hongkong. Some people think that the disease has come to Bombay probably -from Singapore. There was an epidemic at Merv when the Bombay outbreak -appeared, others, however, think that the epidemic at Merv was not that -of plague and that the disease has come from Hongkong. - - - - - _THE LONDON EPIDEMIC OF 1665._ - - -The following graphic and interesting account of the great London -Epidemic of 1665 is taken from Sir William Guy’s book on “Public -Health.” - -“I now turn for a more exact account of the plague of 1665 to the work -of Dr. Nathaniel Hodges, a Fellow of the College of Physicians, resident -in the City, and, as his book shows, in active practice among the -victims of the disease. - -“Dr. Munk, in his roll of the Royal College of Physicians of London, -says that he ‘acquired a great name among the citizens of London; that -he remained at his post and continued in unremitting attendance on the -sick,’ and that ‘during the latter part of his life he received a -regular stipend from the City of London for the performance of his -charitable office.’ - -“Dr. Hodges tells us that about the close of 1664, two or three persons -died suddenly with symptoms of the plague in one family at Westminster, -that some timid neighbours of theirs took fright and removed into the -City of London carrying the taint of pestilence with them whereby the -disease, which existed only in a family or two, gained strength and -spread abroad, and ‘for want of confining the persons first seized with -it, the whole city was in a little time irrecoverably infected.’ - -“In December a hard frost set in, which lasted three months, and during -that time very few died of the plague. But the disease was not -extinguished; for, in the middle of the Christmas holidays, the doctor -was called to a young man in a fever, who after two days ‘had two -risings about the bigness of a nutmeg,’ ‘one on each thigh,’ with a -‘black hue’ and a ‘circle round them.’ By these and subsequent symptoms, -he judged it to be a case of plague. It did not prove fatal. - -“When the frost broke, the disease gained ground and extended into -several parishes; and the authorities issued an order ‘to shut up all -the infected houses,’ so as to prevent ingress and egress. To give -effect to this order, the houses of the infected were to be marked with -a red cross, and to carry the inscription, ‘_Lord have mercy upon us_,’ -and a guard was set whose duty it was to hand food and medicine to the -sick, and to prevent them from going abroad till forty days after their -recovery. In spite of these harsh measures, ‘the plague more and more -increased.’ Nor will this surprise us if we imagine the frantic and -successful efforts that must have been made by the non-infected to -escape, and the temptation to servants and nurses to appropriate and -remove the property of the dying and dead. Indeed, Dr. Hodges accuses -the nurses of strangling their patients, and secretly conveying the -pestilential taint from sores of the infected to those who were well; -and he justifies his accusation of ‘these abandoned miscreants,’ the -Gamps and Prigs of the seventeenth century, by two instances; the one of -a nurse who, ‘as she was leaving the house of a family, all dead, loaded -with her robberies, fell down dead under her burden in the streets,’ the -other of a ‘worthy citizen’ ‘who, being suspected dying by his nurse, -was beforehand stripped by her; but recovering again, he came a second -time into the world naked.’ - -“In spite of the well intentioned measures of the authorities, the -plague continued through May and June with more or less severity, -sometimes in one place, sometimes in another, till the people becoming -thoroughly frightened, flocked out of town in crowds. But the disease -raged with redoubled fury among those that remained. Then the -authorities bestirred themselves to the utmost. They instituted a -monthly fast; and the King commanded the College of Physicians ‘to write -somewhat in English,’ that might serve as ‘a general directory.’ The -college not only obeyed the royal commands, by inventing a ‘_Plague -Water_,’ consisting of a cordial distilled off from a vinous infusion of -a score of very harmless roots, leaves, and flowers, but also appointed -two of their number to co-operate with two chosen from among the -aldermen in attending the infected; while Dr. Glisson, Regius Professor -at Cambridge, and Drs. Paget, Wharton, Berwick and Brookes volunteered -their help, with many others who survived, and eight or nine who fell -victims to their self-devotion, among whom Dr. Conyers receives -honourable mention. - -“Still, in the face of every precaution, the plague continued its work -of destruction, especially among the common people, so as to be called -the ‘_Poor’s Plague_,’ and, in August and September, completely got the -mastery, ‘so that three, four or five thousand died in a week, and once -8,000.’ - -“And here I will follow Dr. Hodges’ example, and try to give you some -idea of the state of things then prevailing. But in doing so I must -shorten and tone down his description. ‘In some houses,’ he says -‘carcases lay waiting for burial,’ ‘in others, persons in their last -agonies.’ ‘In one room might be heard dying groans, in another the -ravings of delirium,’ and, near at hand, relations and friends bewailing -their loss and their own dismal prospects. ‘Death was the sure midwife -to all children, and infants passed immediately from the womb to the -grave.’ Some of the infected ran about staggering like drunken men, and -fell down dead in the streets, or they lay there comatose and half dead; -some lay vomiting as if they had drunk poison; others fell dead in the -market in the act of buying provisions. The plague spared ‘no order, age -or sex.’ The divine was taken in the very exercise of his priestly -office, and the physician while administering his own antidote; and -though the soldiers retreated, and encamped out of the city, the -contagion followed, and vanquished them. Many in their old age, others -in their prime, most women and still more children, perished; ‘and it -was not uncommon to see an inheritance pass successively to three or -four heirs in as many days.’ There were not sextons enough to bury the -dead, the bells ceased tolling, the burying places were full, so that -the dead were thrown into large pits, dug in waste ground, in heaps 30 -or 40 together; and those who attended the funerals of their friends one -evening were often carried the next to their own long home. - -“This is written of a time when the worst had not yet happened. It was -about the beginning of September that the disease was at its height. -Then fires were ordered to be burnt in the streets for three days -together; but before the time had expired, they were extinguished by -heavy rains, which ushered in the most fatal night of all with its -register of more than 4,000 deaths. - -“From this, its culminating point, the plague, ‘by leisurely degrees -declined,’ ‘and before the number infected decreased, its malignity -began to relax, insomuch that few died, and those chiefly such as were -ill-managed.’ Dr. Hodges distinctly states that the pestilence did not -stop for want of subjects, but from the nature of the distemper. ‘Its -decrease was, like its beginning, moderate.’ Early in November, people -grew more healthful, and though the funerals were still frequent, ‘yet -many who had made most haste in retiring, made the most to return;’ -‘insomuch that in December, they crowded back as thick as they fled.’ -The houses were again inhabited; the shops re-opened; the people went -cheerfully to their work; the rooms, in which a short time before -infected persons had breathed their last, were peopled afresh, and many -went into their beds ‘before they were even cold or cleansed from the -stench of the diseased.’ ‘They had the courage now to marry again,’ ‘and -even women, before deemed barren, were said to prove prolific, so that, -although the contagion had carried off, as some computed, about 100,000, -after a few months, their loss was hardly discernable.’ But the next -spring there appeared ‘some remains of the contagion,’ which was easily -conquered by the physicians; and the whole malignity ceasing, the city -returned to perfect health, as after the great fire, ‘a new city -suddenly arose out of the ashes of the old, much better able to stand -the like flames another time.’” - - - - - _GEOGRAPHICAL DISTRIBUTION._ - - -Plague is known in Europe, Asia and Africa, but it has not been known in -the Western Hemisphere. It is said that Mesopotamia is the home of -plague. It has been known as far North as Astrakhan in Asia and Norway -in Europe. During the last fifty years, however, it is chiefly confined -to Asia from Red Sea on one side, and the shores of the Pacific on the -other. Some are inclined to think that the plague was carried from -Himalyan India across Thibet to Yanon in Chinese territory, thence to -Pekoi whence it made its way to Canton and Hongkong. If that be so, then -the plague has accomplished a tour from Northern India _viâ_ China by -Sea route to Southern India within a period of twenty years between 1876 -and 1896. - - - - - _CAUSES_— - - -A disease so fatal in its nature and against which human power is so -futile was in ancient times naturally attributed to wrath of the gods. -Supernatural, astrological, and, in some instances, rationalistic causes -were assigned to it. In the fourteenth century the College of Physicians -of Paris ascribed it to the influence of constellations in India. But -more natural explanations, however, gradually followed. Putrefaction of -dead animals was assigned as a cause in Egypt. Poisoning of water-supply -was also believed to be the cause. Undue heat, rain, watery grain, and -absence of the Etesian winds were thought to generate plague. Leaving -ancient theories on the causation of the disease we find that modern -Scientists divide themselves into two classes: _first_, those who -believe in the germ theory and attribute the plague to a specific germ, -holding that germs can never arise _de novo_; _second_, those who -believe that atmospheric changes and certain telluric conditions or -insanitary surroundings engender the seeds of pestilence which are -carried through air, water or other media. The arguments in favour of -the first theory are, however, so strong and overwhelming, that it is -now almost universally accepted that plague is due to a specific poison -which grows and multiplies under favourable conditions, and that -wherever it occurs it is caused by the implantation of those germs in a -suitable soil. If the soil is not fit, the germs may be sown, but they -will not germinate and, if the soil is fit but the germs are absent, the -disease will not be seen. The soil best suited for the plague seed is -one where insanitary conditions prevail. Dirt and filth, bad -ventilation, and overcrowding are its manure. The history of plague from -ancient times fully illustrates that plague thrives in dirt, filth, -squalor and misery. Diseased grain and want of subsoil drainage are held -to be potent factors in the diffusion of plague. - - - - - _BACILLUS_— - - -During the Hongkong epidemic the great Japanese bacteriologist Kitasato, -who formerly worked with Koch in Germany, discovered a bacillus in -plague-stricken patients, and showed by experiments that these bacilli -if injected into lower animals produced in them symptoms of plague. -Yersin simultaneously discovered the same germs in connection with -plague. According to our modern notion of the causation of the disease, -these germs must be considered to be the specific poison which produces -the symptoms of plague. The bacilli are found in the blood, in the -buboes, and in all internal organs of the victim of the plague. They are -short rods with rounded ends, with a clear space or band in the centre, -readily stained by the aniline dyes and showing very little power of -movement. The size of the plague bacillus varies, and bacilli of same -character, but of less virulent nature, have been found in the soil of -infected places. Some bacteriologists observed some development after -death in the bacilli, this, if confirmed by observations at Bombay, will -be highly interesting from a bacteriological point of view. If mice, -rats, guinea-pigs and rabbits are inoculated with the plague bacillus, -they soon become infected and die, and in their internal organs the same -bacilli are found. They are also found in the soil and dust of houses -where plague patients were kept, but not invariably so. Kitasato found -the bacilli in the blood of patients convalescing from an attack of -plague even three or four weeks after all symptoms have disappeared. It -has been found that the bacillus dies after four days, during which it -is kept at a dry heat, or at the temperature of 80°C. or 176°F. for half -an hour, or at that of 100° C or 212°F. for a few minutes. Its resisting -power to chemical disinfectants is feeble, dying in a 1 per cent. -solution of carbolic acid or of lime water. It develops easily in many -culture media at the ordinary temperature (from 18° to 22°C). An -alkaline solution of Peptone 2 per cent., with from 1 to 2 per cent. of -gelatine, is the best nutrient medium for its cultivation. - - - - - _CONTAGIOUS AS WELL AS INFECTIOUS._ - - -Experience has proved that plague can be transmitted from one person to -another by direct contact; when a case of plague occurs in a house, -other inmates of the house are much liable to be attacked also. Visitors -to the house, medical and other attendants are also liable to be seized -or to carry with them fresh focus of infection. It was, however, found -in the Hongkong epidemic of 1894 that none of the European medical men, -some fifteen in number, nor any of the Chinese students who were on duty -at the plague hospital died. During the Egyptian epidemic of 1835 a -French doctor, Bulard, with the courage of his conviction that plague -was not contagious wore the shirt of a patient who died from plague, and -yet did not contract the disease. Such immunity, however, was probably -due to some circumstances which might be easily explained. In the -Hongkong epidemic of 1894 three Japanese medical men contracted the -disease, and in 1896, some European nurses were attacked. In Bombay the -sad deaths of Surgeon-Major Manser and Miss Joyce prove that contagion -plays an important part in the spread of the disease. - -It has been maintained that plague is a miasmatic or soil-bred disease, -and that the germs find in earth, water or in some form of fermenting or -decomposing material a suitable nidus for growth. In this sense it is -like malaria, which is endemic in a particular suitable area appearing -and disappearing according as climatic or other conditions are -favourable or unfavourable. The Chinese have a peculiar idea of the -infection of plague. They consider that the plague rises from the soil -and believe that it first attacks small animals with breathing organs -near the soil, such as rats, then animals with breathing organs a little -higher, such as poultry, pigs, dogs, goats, cows, so on till it reaches -man, whose breathing organs are higher from the soil than those of other -animals. - -The rats are undoubtedly attacked with plague before and during its -prevalence among human beings, and they play an important part in the -spread of its infection. In Kumaon this rat plague was observed by the -people, and was recognized as a forerunner of the plague. The _Times of -India_, September 30th, 1896, contains the following:—“It was known more -than a month ago to all the people of Mandavi and to all the municipal -sweepers in the district that the rats were dying in thousands all over -the districts. They were found dead and dying almost everywhere, and in -places where dead rats were never found before.” In Bombay an instance -has been reported of a man trampling with bare foot on a rat which was -seen slowly passing in a room and getting attacked by the plague soon -after. Pigs, dogs, snakes, and jackals are said to be also affected by -the plague. It will be seen that flesh-eating animals are the sufferers, -due evidently to their eating plague flesh. Snakes swallow rats, and -rats become infected by consumption of poisoned material or from -infected soil or by their cannibal habit. Like other diseases due to a -specific germ, the infection of plague may be caught from various -sources such as the following—(_a_) By means of breath. Plague dust and -dirt are very potent infective agents. A man getting a whiff of dust -from the floor of a room in which there is a plague patient blown into -his face may get the infection. Sweepers and others engaged in -conservancy are, therefore, easily attacked. (_b_) By food or drink. -Grain adultered with sand or earth infected by rats may be a source of -infection. Food may also be infected by flies or diseased rats (_c_) By -direct inoculation through any abrasion in the skin or mucous membrane. -People with bare feet are, therefore, more liable to catch the -infection. The infection may be spread by infected linen, bedding, -furniture and fomites. The discharge from buboes contains the germs, and -is, therefore, highly poisonous. The fæces, the urine, the sputum, the -fur on the tongue are also infective. If the theory be true that the -poison attaches itself to the soil, then persons living on ground-floor -are more liable to the infection, and a floating population less so. -Dust laden with germs is the principal agent in the diffusion of plague -as that of any other germ disease. Professor Aoyama of Tokyo, whilst -making a _post-mortem_ examination, scratched the left third finger and -was attacked with the plague, also Dr. Ishigami, assistant to Kitasato. - - - - - _NATURE OF AN EPIDEMIC._ - - -Plague is a very slow disease; it takes some weeks to travel from one -quarter of a city to another. It took nine months to travel from the -city of London to Soho, and ten from Hongkong to Macao—a distance of 30 -miles. Thousands of persons from Canton and Hongkong sought shelter at -Macao, and there was free communication between these places, still -Macao became affected nine months after plague ceased at Hongkong. When -plague is first imported in a place, for three or four weeks isolated -cases occur in one neighbourhood. An epidemic may last only a few weeks -or months, but may extend over several years in sporadic form and a -recrudescence takes place abruptly. In Mesopotamia plague declines and -becomes dormant with the setting in of the hot weather, its activity -reawakening in winter and gathering force with the advancing spring. The -same was the case in Egypt. In Constantinople, on the contrary, as well -as in England, the disease was dormant during the cold months but became -active during the hotter. In England, September was the month of -greatest prevalence. In the epidemic at Bengazi in 1858 as well as in -Mukai in 1863 famine and plague were found together. That a water-logged -soil favours famine was illustrated during the epidemic on the Lower -Euphrates in 1867. In Persia and Arabia many epidemics were self-limited -and spontaneously came to an end after spreading on a certain area, -while, on the other hand, it has been known to obtain an endemic -foot-hold, the virus remaining from year to year, and, occasionally -under the influence of meteorological or unknown causes, becoming -epidemic among the population. - -_Race._—No race seems to enjoy an immunity from the plague. - -_Geology and Climate._—Except the new hemisphere the plague has found -congenial soil everywhere. It thrives as much in high and dry altitudes -as in low-lying places, as much in overcrowded towns as in sparsely -populated semi-desert regions. In temperate regions it has been known to -rage in summer, but in Astrakhan it prevailed when there were several -feet of snow on the ground. On the Volga it prevailed during the -severest cold (1878-79), as well as in the extreme heat of Smyrna -(1735). In Bombay it commenced at the end of an exceptionally dry -season, as it did in South China. During the Hongkong epidemic the rains -increased it. The increase of the epidemic at Hongkong with the rains -was probably due to the fact that the rains drove people into infected -houses, instead of sleeping outside, as they did in summer when the -weather was good. It has been said that plague flourishes in a warm -moist atmosphere and dry hot air kills it, but there are records of -plague thriving in conditions antagonistic to this theory. A temperature -between 60° and 85°F. is said to be very favourable to it. - -_Sex and Age._—Both sexes are equally liable. It is said that people -between the ages of 10 to 30 are frequently attacked. But experience -shows that children and old people are alike liable to attack. In Bombay -the disease has occurred most frequently between the ages of 20 and 30, -and the male sex has suffered more than the female. - -_Occupation._—During one epidemic, water-carriers, or those who used -much water, or who dealt in oil and fats were found comparatively free; -but this observation cannot be relied upon. Those whose business -requires them to come much in contact with the sick, and also those who -are engaged in cleaning are naturally more exposed to infection. It has -been said that one attack generally protects from a second, which, if it -occurs, usually runs a mild course. - -_Sanitation and Personal Hygiene._—Plague, germs thrive in filth. Bad -hygienic conditions, over-crowding, insufficient ventilation, and -absence of sunlight in dwelling houses, accumulation of decomposing -organic matter, effluvia from bad drains, sewer and cesspools are causes -that favour the growth and dissemination of an epidemic of plague. When -it attacks a town, it, therefore, naturally selects first the poorer -classes who live in ill-ventilated and over-crowded houses. -Over-crowding within dwelling houses is a fertile source of producing a -constitution fitted for the reception of plague-germs. Such portions of -towns where there is much congestion and over-crowding suffer most. -Scarcity of food favours plague. It has been called _Miseriæ Morbus_, or -the disease of misery, and the plague of London was called the “poor’s -plague.” In Kumaon there is the usual custom of keeping cattle in the -lower room of a hut, where a crowd of cattle stand udder deep in fœtid -straw. In one of the rooms of the upper storey grain is kept, and in -another the whole family sleeps with doors and windows shut. Such -conditions are undoubtedly very favourable to plague. - -_Predisposition._—Chill and exposure to cold, indigestion and any other -disease producing a debilitated condition of body, fatigue, overwork, -error of diet, mental emotion, and a terror of attack are predisposing -causes. Catarrhs often predispose an attack. - - - - - _INCUBATION._ - - -Or how long does it take for the poison to develop symptoms after -infection: generally three to six days, but the period may be up to ten -days. The period varies with the virulence of the poison. The germs, -however, remain active outside a host for a long time. An instance has -been reported, in which a man, after handling some ropes which 20 years -previously had been used in the burial of plague corpses, took the -disease and died of it. - - - - - _SYMPTOMS._ - - -The usual premonitory symptoms are headache, loss of appetite, a feeling -of general depression and aching of limbs. These symptoms may either be -mild or may appear at once in very aggravated form; violent headache -being usually of an acute dull character, accompanied by throbbing in -the temples, giddiness, sleeplessness, palpitation, a feeling of -oppression of the chest, even mental delusion may appear on the first -day. The look of the patient is anxious, pale and cyanosed. The -expression of the face resembles that of a man who has had no sleep for -two or three nights but is being overpowered with the fatigue consequent -to it. These symptoms are usually ushered in with a rise in the -temperature. Well-marked rigor is usually not seen, but a slight shiver -or chillness is complained of. Pulse is full, bounding and rapid—130 or -more per minute. Respiration is difficult and accelerated even to 40 or -50 per minute. Skin is dry and hot, face puffed, conjunctivæ congested. -Sense of hearing is dull. Speech is thick and faltering. Tongue is dry -and coated with greyish white or dark brown heavy fur. Violent thirst is -present. Sometimes Patchiæ appear on the skin. In a few hours, or a few -days after the appearance of the first symptoms, a swollen gland appears -either in the neck or axilla or groin. The gland most commonly affected -is one or some of the femoral chain. An inguinal, axillary or a cervical -gland may also be affected. A number of glands may swell at one time or -glands in all the above situations may be felt painful and swollen. The -glands of the neck are most frequently attacked in children. Pains in -the lower part of the abdomen and along the spine indicate affection of -internal lymphatic glands. In some cases the first symptom noticed is a -swollen and painful gland, but fever soon manifests itself. The -glandular enlargement may antedate, coincide with, or follow the rise in -temperature. Sometimes only pain in the gland is complained of, but no -swelling is observed. The temperature rises gradually and goes up to -104°, 105° or 106° F. In some cases a temperature of 108° was observed. -There may be a marked morning fall and an evening exacerbation, which is -a favourable sign, or the temperature may remain high persistently. All -the above symptoms become soon aggravated when the second stage or stage -of acute development of the disease appears. Brain symptoms show -themselves. Lowson noticed four distinct type of brain symptoms—(1) -comatose, when the patient lies paralysed, mind and body; (2) wildly -delirious, when the patient struggles and fights and still retains a -fair command of rational speech; (3) apathetic, when he lies perfectly -quiet but is drowsy; (4) convulsive, which condition occurs when there -is inflammation of the meninges or hæmorrhage in the brain. - -In this stage all symptoms of a pronounced typhoid condition supervene. -Tongue becomes parched and black. Sordes cover the teeth. Gradually a -somnolent condition and low muttering delirium supervene. In some cases -the delirium is violent and furious, while in others it culminates in -complete stupor and coma. Picking of the bed-clothes, and subsultus -tendinum are common, and the urine and fæces are passed involuntarily. -The pupils are dilated. The skin is bathed with profuse perspiration. -The pulse is dichrotic and compressible, and gradually becomes -anachrotic and intermittent till it finally fails. The area of cardiac -dullness is increased and pain in the cardiac region is complained of. -Heart begins to fail rapidly. The usual complications of this stage -are—(1) meningites; (2) hæmorrhages; (3) severe gastric disturbance, -such as vomiting, diarrhœa, hiccough. As a rule, constipation is found -during the course of an attack, but diarrhœa, even severe, may appear. -There may be pain in the abdomen. Bladder may be distended and a -catheter may be necessary to evacuate it. Cystitics often develop. Œdema -of the lungs, pleurisy and pneumonia may also complicate a case. -Hæmaturia, hæmoptysis and hæmatemesis may be seen. Bronchitis and -hypostatic inflammation may occur. The urine always shows presence of -albumen. Death may take place from cardiac failure or from any of the -above complications. Death may take place within three or four days, -though in some virulent cases the patient dies within twenty-four hours. -If the primary collapse is tided over, there is great chance of -recovery, still deaths often occur of complications several days after -the attack. - -In mild cases the second stage is not so severe, and temperature may -fall by lysis or crisis—the latter being rare. - -The glands in the meantime become swollen and are surrounded by a -sero-sanguinous exudation. The surrounding parts are œdematous. The -glands usually do not suppurate, but they may do so and slough. The -usual course after their enlargement is one of four: (1) resolution; (2) -lengthened period of enlargement; (3) suppuration; (4) sloughing. In -cases that recover the symptoms gradually take a favourable turn and -recovery is as rapid as the attack. The fever slackens, the pulse -becomes stronger, the tongue moist and the typhoid symptoms gradually -pass away. The buboes either suppurate or subside; symptoms of secondary -pyaemic conditions, however, may sometimes develop. Deviations from the -typical course are, however, often observed. Some cases take an -extremely rapid course, the patient succumbing within from 12 hours to -two days. The duration of the disease varies between a few hours and a -few weeks, but on an average up to the commencement of the convalescence -it seems to last from 6 to 10 days. During convalescence the vitality of -the issues are very low. Head symptoms sometimes persist for some time. -Temper is irritable. The sloughing glands often take a long time to -heal. Convalescence is soon established. - - - - - _VARIETIES._ - - -Just as before an epidemic of cholera visits a place, it is usual to -observe cases of mild diarrhœa, and indigestion prevailing amongst its -population; so, before plague actually breaks out, it has been found -that cases of buboes and parotites with fever are commonly observed. -Such cases were called _Pestis Minor_ at Astrakhan. “No one died from -the disease _per se_, but few people were confined to bed.” It is not -known whether in _pestis minor_ the plague germs could be found; but -presumably not. - -Drs. Simpson and Cobb of Calcutta have described what is called _Pestis -Ambulans_, or an ambulatory form of plague, in which plague germs have -been found. The commonly accepted types of plague are (1) Fulminant; (2) -Typical; (3) _Pestis Minor_ (including _ambulans_). The cause of the -first two is the bacillus discovered by Kitasato, and they are very -fatal, of the third, the cause may be an allied bacterium less potent to -produce toxic effects on man, and it may come and go but plague may not -break out. In ambulatory form the patient has slight fever and glandular -enlargement, but he can move about. - - - - - _DIAGNOSIS_— - - -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._ - - -The mortality from plague may be about 90 per cent. or more when the -epidemic is at its height. In the beginning, or towards the end of the -epidemic, the mortality is less, as it is the case with all other -epidemic diseases. The average mortality at Bombay has been 84 per cent. -and in Karachi 89 per cent. It is, therefore, more fatal than all other -epidemic diseases, the mortality from cholera during the height of an -epidemic being about 60 per cent. - -In children and in the aged the disease is more fatal than in healthy -adults. Cases in which the bubo appears early and is single, or in which -there is a distinct morning remission, or less general prostration or -free perspiration, or in which there is no diarrhœa, have greater chance -of recovery. Rapid suppuration of the buboes indicates a favourable -termination. Buboes do not suppurate as a rule until the primary fever -has fallen. On the other hand, carbuncles, multiple buboes (specially on -the neck), meningitis, hæmorrhages, pleurisy, pneumonia, diarrhœa, -gastric irritation, cyanosis, jaundice and continued pyrexia are -unfavourable signs. - - - - - _MICROSCOPIC AND MACROSCOPIC APPEARANCES._ - - -Bacilli are found in all the internal organs, notably in the spleen, in -blood and in the enlarged glands. - -Body does not show much emaciation; decomposition commences early. Black -hæmorrhagic patches are often found on the skin. The brain and membranes -are congested. Sanguinous or serous effusions are found in serous -cavities. Right side of the heart is dilated and is usually found full -of coagulated or liquid blood. Cardiac muscles pale. The liver is -enlarged and congested. The spleen is much enlarged, soft and congested. -Hæmorrhagic patches have been found in the stomach. The mesenteric -glands are enlarged. Kidneys congested. Bladder is sometimes found -filled with bloody urine. The buboes are sometimes found to be soft and -caseous. The tissues surrounding them are infiltrated with a reddish -gelatinous exudation. The whole lymphatic chain from groin to the glands -of the sacral or lumbar plexus, or from the axilla and neck to the -glands of the mediastinum are affected. The internal glands are found -more or less enlarged, injected and infiltrated with sanguineous fluid. -The lymphatic follicles and Peyer’s patches in the intestines are found -swollen. Hæmorrhages are found in the mesentery. - - - - - _PREVENTION._— - - -It is evident from what has been said that to prevent plague our efforts -should be directed in two ways:—(1) To prevent the importation of germs; -(2) to make the environment of a place such that the germs, even if -imported, may not find suitable condition for their growth. To -accomplish the first we need (_a_) inspection of people coming from -infected places; (_b_) stopping importation of such articles as may -carry infection with them; (_c_) quarantine, a word which owes its -origin to the fact that, daring the epidemic of plague at Milan in 1527, -patients when cured were despatched to lazarettos and detained there 40 -days. - -For the second, we require (_a_) sanitary precautions by guardians of -public health; (_b_) observance of rules of personal hygiene by which -good health can be maintained. - -(1). Wherever possible a medical inspection should be made to prevent -importation of the disease. This is, however, a very difficult matter, -and one unforeseen difficulty was experienced at Sukkur, where it was -found that people booked to stations short of Sukkur, and rebooked at -stations on the other side. Still this measure is highly important, and -should be carried out most rigorously as long as there is any chance of -importation of plague into an unaffected country. It is needless to feel -the pulse of the patient; his gait, temperature, and look would afford a -great deal of information. Information should be obtained from where the -patient is travelling. An examination should also be made of clothes. -Dirty clothes, soiled linen and rags should not be allowed to pass -through an inspection post. - -(2). There should be a disinfecting or sterilizing room fitted with a -steam sterilizer in all large railway stations, where all goods should -be disinfected. Mail bags should also be subjected to this disinfection. -Transmission of such goods as corpses, used clothes, rags, waste paper, -fur, hide, feather, and fish should be entirely suspended. - -(3). If quarantine is imposed, it should be for a period not less than -ten days. Every arrangement, however, should be made for suitable -accommodation and sanitation in quarantine camps. In a quarantine camp -new arrivals should not be mixed up with those who are already in -quarantine. - -(4). Ships from infected ports should be carefully watched. If any -infection is discovered, then isolation of the sick, disinfection of the -ship and quarantine are required, but ships with clean bills of health, -and if ten days have passed since its departure from the infected port, -may be admitted after medical inspection. It must, however, be borne in -mind that rats could easily carry infection from one port to another -without any fear of detection. These facts show that medical inspection -and quarantine may be useful, but they can never be perfect, and -therefore the principal safeguard of a place lies in the improvement of -its sanitation, and therefore greater attention and energy should be -directed towards it. - - - _Sanitary Measures that should be taken by Municipal and Railway - authorities._ - -(1). All filth should be removed from the vicinity of towns and villages -and _burnt_, and no filth of any kind should be allowed to remain within -an inhabited area for any length of time. - -(2). All private and public latrines and public urinals should be -cleaned and disinfected daily. All receptacles used for night-soil -either in the latrine or for transport should be daily disinfected. - -(3). Latrine accommodation, according to the requirements of the -population, should be provided. - -(4). Drains should be well washed and flushed with a disinfectant -solution. In towns where there is an underground sewer, it should be -well flushed and ventilated, and a disinfectant solution used for -cleaning it. A house-to-house examination should be made to ascertain -that all house-connections are properly and efficiently trapped. -Deposits in the sewer should be taken out and suitably disposed off -after disinfection. - -(5). Special attention for cleansing should be given to the following:— - -Cesspools, privies, cow-houses, stables, slaughterhouses, markets, -workshops, common lodging houses, serais, bustees, and crowded quarters -of a town. - -(6). All public roads should in the dry season be watered with a weak -disinfectant solution. - -(7). Pure drinking water should be supplied. All articles of food should -be inspected. Musty and decomposing grains should not be allowed to be -sold. The meat market, dairies and bakeries should be under strict -sanitary supervision. - -(8). Over-crowding in houses should be prevented. Steps should be taken -for spreading out the population of much over-crowded and congested -parts of towns. - -(9). Lime in a dry state and in solution should be abundantly used in -drains, &c. - -(10). All railway carriages travelling through infected areas should be -daily washed with a reliable disinfectant solution, such as 5 per cent. -carbolic acid. - -(11). Railway platforms, waiting rooms and halls, and latrines should be -frequently cleaned and disinfected. - -(12). There should be a system of house-to-house inspection to ascertain -the sanitary condition of dwelling-houses, and also to find out, as far -as possible, the condition of health of the inmates. - -Common lodging houses, serais and houses of a similar nature should be -most carefully examined. - -(13). If plague breaks out, then isolation of cases is a great -necessity. When practicable, such isolation may be done in the house of -the patient. The patient should be kept in a separate room apart from -those where other inmates of the house live. A temporary room could be -put up on the roof of a house or in the compound, if there is any, or a -tent may be pitched. Where possible, all healthy inmates of the house -should at once remove themselves in camp leaving only such near -relatives who must attend and nurse the patient. For patients living in -lodging houses, or, where there is no means of such isolation as stated -above, segregation in special isolation hospitals should at once be -done. The isolation hospitals should be separate for each of the -following classes—(_a_) for lower class people; (_b_) for middle class -people; (_c_) for such people of the middle or upper class who may chose -to pay for their expenses. It is needless to say that there should be -special hospitals for women, where only female attendants and nurses -should be employed. Hospitals should be provided with means for free -ventilation, both for the sake of patients as well as attendants. No -other disease requires more careful nursing than the plague, therefore -ample nursing staff should be provided. The hospitals should have a -separate observation ward and a separate convalescent ward, and by no -means doubtful cases should be mixed up with confirmed cases. -Disinfecting apparatus, sterilizers, good water supply and special -laundry are other adjuncts essentially necessary for a plague hospital. -Greatest care is required in the management of such a hospital, and only -trained men should be employed. - -Suitable means for ambulance should be provided, and should be had ready -within convenient distances. They should be thoroughly disinfected after -the conveyance of any case. Ambulance carts or doolies should be -comfortable, for physical exertion and exhaustion, attending a long -journey in the early stage, greatly compromise chance of recovery. - -Burial within inhabited areas of a town or village should be stopped. -Dead bodies should be removed under strict precautions for disinfection -and disposed off quickly. Bodies should be buried deeply—4 to 6 feet. - - - - - _PRIVATE HYGIENE._ - - -I. Houses and compounds, stables, kitchen and outhouses should be -thoroughly cleaned, and they should be whitewashed with lime. Air-tight -dustbins should be kept in the house. - -II. Rooms, specially bed-rooms, should be well ventilated, attention -should be paid to the condition of the floor, which should not be damp, -and care should be taken that rats may not infest the house and spaces -under the floor. If dead rats are found in the house, they should be -removed and burnt, and the place thoroughly disinfected. - -III. House drains should be cleaned and well flushed with a disinfectant -solution. - -IV. Nowhere in the house or compound should any kind of organic refuse -be allowed to accumulate. Better not use any organic manure in the -kitchen garden or house garden during an epidemic. - -V. Articles of food should not be allowed to remain uncovered on the -table or elsewhere, for there is chance of their infection by flies, -mice, or rats. - -VI. Clothes received from the dhoby’s house should be again boiled in -water, dried, and then used. - -VII. Bed-clothes and wearing apparel should be aired and exposed to the -sun daily. As frequently as possible floors and passages should be well -washed with a disinfectant solution and then well dried. - -VIII. There should not be any over-crowding in bed-rooms. - -IX. Drinking water should be boiled before use. Raw vegetables, such as -salad, cucumber, &c., should only be used after thoroughly washing them, -and then with vinegar. - -X. Personal cleanliness should be strictly observed. Daily bath, -cleaning the teeth with carbolic tooth powder, and carefully washing -hands and mouth before and after meals are essential. - -XI. Those who have to attend on plague cases should be very careful. -Hands should be thoroughly washed with a disinfectant solution, and a -nail brush used soon after the patient or anything in contact with him -is touched. A bath to which some antiseptic is added should be taken -immediately after coming in contact with plague patients. Workers in -plague hospitals should be warned about scratches or wounds on their -bodies. Use of respirators with an antiseptic sprinkled over the -entrance valves is recommended. Only very healthy people should approach -plague cases. On the appearance of slightest headache, languor, or fever -an attendant should be relieved from duty. - -XII. As a prophylactic 5 grains of quinine sulphate may be taken twice -daily, or a small bottle containing eucalyptus or some other volatile -disinfectant, may be carried in the pocket, and a few drops may be -occasionally poured on the handkerchief. Smoking good tobacco may have a -prophylactic value. - -XIII. If plague occurs in the house, the following steps should be -taken:— - -(_a_) The patient should at once be put in bed and kept in a temporary -room, which may be put up on the roof of a house. No healthy inmate of -the house should go in that room or have any connection with the sick, -except those who have to nurse the patient. - -(_b_) All discharges, fæces, urine, sputum, vomited matter, &c., should -be taken in vessels with disinfectant solution in it, and some quicklime -should immediately be sprinkled over them. On no account should anything -leave the room but to be disinfected. - -(_c_) Floor and bedsteads should be washed with a disinfectant solution, -clothes and other articles that touch the patient should be carefully -disinfected. Crockery and glass should be scalded. If great care and -cleanliness are not observed with regard to the bed and body linen of -the patient, the infection may be diffused through the air immediately -around the patient. - -(_d_) A medical man should be at once sent for. Delay is fatal. - - - - - _INOCULATION AGAINST PLAGUE._ - - -M. Haffkine, of cholera inoculation fame, has commenced to inoculate -against the plague under the same principles on which his inoculation -against cholera is based. By injecting into the body an attenuated virus -of plague, a very mild attack is produced, which in people inoculated -has proved harmless. This mild attack, it is thought, would protect the -system from more potent forms of the poisonous germs. The inoculation -for plague is still in its experimental stage, and cannot, for obvious -reasons, be applied to a large population. Medical attendants, nurses -and others who, by call of duty, have to constantly come in contact with -plague patients may, however, take advantage of this means of -protection, which, in the hands of M. Haffkine, may yield good results. -Yersin also claims for his serum prophylactic value. In this and all -other matters connected with bacteriology, such as germs, -sero-therapeutics, &c., the medical profession now-a-days receives a -good deal of satirical remarks from sceptical lay public. It is natural -that it should be so, for the science of bacteriology is still in its -infancy, and many of its practical applications are still in their -experimental stage. But undoubtedly the science is advancing, and by its -aid we are now better able to understand diseases and their nature. Many -facts have been demonstrated and proved with precision. What is -disbelieved to-day, may, however, be believed tomorrow, for, with all -human attempt to reveal secrets of nature, such is the case. Readers of -Smollet’s Roderick Random may remember how in the Surgeon’s Hall one of -the examiners said:—“I affirm that all wounds of the intestine whether -great or small are mortal.” Now, however, if a man dies of a wound of -the intestine, the unfortunate doctor in whose hand such a casualty -takes place runs great risk of being charged with malpraxès. - - - - - _TREATMENT._ - - -I. _Hygienic._—The patient should take to bed immediately on the -appearance of the first symptoms. The room should have means for free -ventilation, and the temperature in it should be between 60° to 70° F. -The air of the room may be cooled by a block of ice. The room should be -kept clean, and there must not be in it any curtain, carpet or hangings. -The floor and bedsteads should be daily washed with a disinfectant -solution. A position of absolute rest in bed is to be maintained -throughout the illness. - -Bedpan and urinal should be always used. Bedclothes should be light and -warm. Wearing apparel if saturated with perspiration should be changed. -It is best to have two beds side by side so as to be able to move the -patient easily from one to another for cleansing purposes. Mattresses -should be suitably protected from penetration by the discharges. The air -of the sickroom can be made antiseptic by placing pieces of blotting -paper saturated with eucalyptus oil or phenol on plates about the -apartment or by pouring carbolic acid on hot water in a plate. The -doorways should be curtained by a sheet wet with disinfectant solution. -Great cleanliness of the body of the patient should be enforced by cold -sponging with an antiseptic solution. Skilful nursing is essentially -necessary. The motions should be disinfected by strong antiseptics such -as quicklime, carbolic acid, &c., as soon as they are passed. - -II. _Dietetic._—From the commencement of the disease the diet should be -liquid and nourishing. Milk is best. The quantity for adults should not -be less than three or four pints in the twenty-four hours. It must be -given in small quantities at short intervals. Soda, potash or plain -carbonated water may be mixed with it. Barley water and thin sago water -may also be given. If the patient’s vital powers are low, the milk may -be peptonised by using Fairchild’s powders or by adding a little of -Benger’s Liquor Pancreatices. In cases when milk cannot be taken in -sufficient amount, animal food may be given in the form of plain meat -broth. Egg-flip with or without brandy may also be given. It is useless -to give strong meat essences when the digestive powers are seriously -impaired, and excess of zeal in this direction does a great deal of -harm. These accumulate in the intestinal canal and form a fermenting -mixture in which poisonous ptomaines form. Throughout the attack the -patient’s strength should be husbanded as carefully as possible. When -there is thirst, water, or iced water, or iced beer or stout, or -ice-cream, or fruit _sherbat_ should be given. During convalescence -great care should be taken of diet, for then the vital powers are at a -very low ebb. - -III. _External._—In order to lower the temperature rubbing of the skin -with oil from the commencement of the disease has been recommended, but -this procedure is, I think, of no use. I suggest, however, that when -temperature is high 15 drops of Creosote may be rubbed near the axilla. -During height of fever, the body may be lightly sponged all over, twice -or thrice a day, with the following solution:— - - Thymol 40 grains. - Spirit Lavendula 2 oz. - Spirit Vin. rectif. 3 ” - Acid Acetic dil. 3 ” - Aquæ Rose add 16 ” - -Mustard plasters to limbs and over the heart should be given when there -are signs of failing heart and circulation, and over the epigastrium -when there is vomiting or hiccough. Smelling salts and strong ammonia -should be applied to the nostrils for their restorative action. Blister -over the nape of the neck is useful when cerebral symptoms are present. -Ice caps over the head is very useful and should be applied -continuously. The enlarged glands may be fomented with hot water or -spongio-piline wrung out of hot antiseptic solution. When they are much -painful, poppy or belladonna may be added to the water. Belladonna with -glycerine should be applied in the beginning and iodine afterwards. Hot -corrosive sublimate fomentations are also useful. If the glands -suppurate, they should be opened aseptically and dressed with -antiseptics. Proper drainage should be provided. - -IV. _Internal._—Knowing as we do that the plague is due to the toxic -products metabolized by a pathogenic bacillus, the question comes—would -an antiseptic treatment be of any use? Can we by any means induce an -antiseptic action on the blood, or have we any drug which can act as -antitoxin? It must be at once stated that no drug that has been tried -yet fulfils the above conditions. The claims of quinine, however, should -be taken into account. This drug in small repeated doses acts as a -general antiseptic. I would, therefore, advocate its use especially in -the early stages. Plague is a disease in which collapse sets in early -and cardiac asthenia is a very early complication. There is, therefore, -great urgency for early stimulation. Alcohol may be given freely, but at -the same time it must be remembered that if the organs of elimination -are not acting properly, alcohol may do harm. For their stimulant -effects whiskey or iced champagne may be given. Carbonate of ammonia or -spirit ammonia aromatic are held to be very useful stimulants in plague -cases. They may be given in combination with cinchona, digitalis and -ether. A prescription like the following may be useful:— - - Ammonia Carb. 5 grains. - Chloric Ether 20 minims. - Sulphuric Ether 15 ” - Tint. Digitalis 5 ” - Tint. Cinchona 1 dram. - Aquæ Camphor 1 ounce. - Every three hours. - -For cardiac asthenia, the following may be tried:—(1) Caffeine, -hypodermically, 5-grains dissolved by the aid of 5 grains of Sodium -Benzoate in 20 minims of warm distilled water and injected three or four -times a day if needful; (2) Ether or ethereal solution of camphor -hypodermically; (3) Strychnine, hypodermically, beginning with gr. 1/60 -every four or six hours till gr. 1/16 is injected, or Liquor Strychnia -in 5—10-minim doses every four hours; (3) Musk may be given in 5-grain -doses, or as in the following mixture:— - - Pulv. Moschi 10 grains. - Mucilage Acacia 2 drams. - Syr. Aurantii 2 ” - Aquæ Camphor ½ ounce. - To be given every 6 hours. - -Digitalis does not always give good results, a fact which Lowson -attributes to some inflammatory or fatty degenerative changes in the -small vessels giving rise to a tendency to hæmorrhage. Stropanthus may -be substituted. Transfusion of blood a hot saline solution and -inhalation of oxygen have been recommended for collapse. Dr. Viegas of -Bombay recommends Liquor Hydrasgyie Perchloride 10 to 15 minims every -four hours if there is no albumen in the urine. Dr. Dimmock has advised -subcutaneous injection of Guaicol 10 or 15 minims every two hours. -Permanganate of Potash 5 to 12 grains in 24 hours has also been -recommended. Dr. Blaney has recommended Medritina in two-dram doses -every two hours when the kidneys are involved. Camphor has been -recommended by some as a cardiac stimulant. - - - - - _TREATMENT OF SYMPTOMS._ - - -(1). High temperature may be reduced by antipyretics, such as antipyrin, -phenacetin, antifebrine, &c. These drugs produce profuse perspiration -and a certain amount of depression; it is, therefore, advisable to -restrict their use during the first few hours only, and if not found -responding, they should be dropped altogether. Pyrexia is but a sign of -the intensity of the activities of the infective agent, and by -artificially reducing the body heat we really do not lessen the -virulence of the poison, as shown by the rise of the temperature again -as soon as the action of the antipyretic subsides. Hyperpyrexia itself -is, however, an injurious symptom, and when there is long continued high -temperature it is necessary to reduce it, either by an antipyretic, -quinine or cold bath, or cold sponging. Cold bath is not suitable in -plague patients on account of the movement of the body which it entails, -and also on account of the serious cardiac depression which accompanies -the disease. Two grains of phenacetin with 1 grain of hydrobromate of -quinine is a safe antipyretic. Brandy and tepid sponging are also very -useful. - -(2). _Brain symptoms._—For headache a mustard plaster behind the upper -part of the neck and over the occiput. Ice cap or Lieter’s tube or plain -water should be applied over the temples and scalp. Nervine sedatives, -such as Potassium Bromide, may be given for insomnia when there is not -much depression. Otherwise full doses of alcohol may be tried. Opium -should not be used, but in mild cases, without great depression, 10 to -20 minims of Liquor Opii sedativus with 30 minims of Sal Volatile in an -ounce of camphor water may be given to soothe nervous unrest. For -insomnia Lowson speaks highly of Morpinæ gr. 1/8 to gr. ½. Hyoscine gr. -1/200 to gr. 1/75 may be tried. Meningites should be treated by cold to -the scalp and counter-irritation to the nape of the neck and occiput. - -(3). _Hæmorrhages_ may be treated by Ergot or Ergotin internally or -hypodermically. When there is much hæmorrhage, use of alcohol should be -partly suspended. - -(4). If there is constipation, a dose of calomel may be given. In the -beginning there is almost always constipation, which should be removed -by a dose of calomel followed by a saline. Diarrhœa may be checked by an -enema of opium. Two grains of Dover’s powder and 10 grains of tannin -mixed with an ounce of gum mucilage and with two or three ounces of warm -water, arrowroot or starch may be used for injection. Salol in 10-grain -doses every 4 hours may be given for diarrhœa. For vomiting and hiccough -sinapism over the epigastrium, sucking of ice, and for thirst acidulated -water with syrup of lemon are recommended. Coma must be promptly met by -cold effusion if there is pyrexia or by rectal injection of strong -coffee. The bladder of the patient should be carefully watched. -Pneumonia and other complications should be treated under general -principles. - -When temperature falls and convalescence begins, the stimulants should -be lessened, and afterwards a tonic with quinine, acid nitromuriatic -dil., tincture calumba or quassia may be given with infusion aurantii. - -_Serum treatment._—The whole system of serum therapeutics is due to the -genius of Pasteur. Diphtheria and tetanus are diseases that are caused -by specific germs and are now successfully treated by immunised serum. -Tetanus can be prevented and even cured by the injection of serum of -other animals vaccinated against this disease: this process has been -applied by Yersin for producing a plague serum, for which a prophylactic -and curative power is claimed, and this serum may be called plague -antitoxin. Yersin treated his first case in Canton. At Amoy, the people -were less averse to treatment, and in 10 days he was able to treat 23 -with two deaths only. As yet Yersin’s serum has been tried in the -declared diseases, but Yersin also proposes to use it as a preventive. -Haffkine also proposes to make use of his serum for curative purpose. -Yersin’s serum is older than Haffkine’s, otherwise bacteriologically -they are identical. The subject is in far too unsettled a condition at -present, but it has no doubt a hopeful future before it. - - - - - _DISINFECTION._ - - -Substances which can prevent infectious diseases from spreading by -destroying their specific germs are called disinfectants. These -disinfectants can kill pathogenic germs. Heat is a most powerful agent -in killing-germs, therefore anything which is subjected to prolonged -boiling becomes sterile or germ-free. For purification of clothes and -bedding, heat is the best agent, either by boiling them in water or by -placing them in a hot-air chamber. The usual arrangement is a furnace -with the smoke shaft passing under or on one side of a brick chamber and -with a hot-air blast from a shaft running through or under the fire into -the chamber itself, or into a passage below it, whence it passes into -the chamber through a valve; an exit for the hot-air is provided at the -top of the chamber, the clothes are suspended in the chamber, at a -little distance from the walls. Various kinds of ingenious apparatus -have been recently contrived and are used. Steam disinfecting chambers -are necessary for the disinfection of clothes, &c., of a large -population, and all large towns and railway stations should have them. -High pressure steam in an apparatus contrived for the intermission of -its pressure is found to give the best heat penetration to large -non-conducting articles such as bedding. Fumigation by burning sulphur -or chlorine is a very useful method for disinfection of rooms. Large -bonfires of sulphur may also have a beneficial effect on the air. - - - - - _PURIFICATION OF A ROOM AFTER PLAGUE CASES_— - - -All woodwork should be thoroughly cleansed with soft soap and water, to -which a little carbolic acid has been added. The walls should be scraped -and then washed with hot lime to which carbolic acid should be added in -the proportion of one pint to four gallons of water. Then the room -should be fumigated for 3 hours, with all doors and windows and the -chimney being closed, sulphur about 1 seer for every 100 cubic feet of -space should be put in a metallic dish, a little alcohol is poured on -it, and it is lighted. After 3 hours the doors and windows should be -opened and kept open for 24 or 36 hours. Rooms may be disinfected by -chlorine. Carbolic acid in 5 per cent. solution is useful for all -ordinary purposes, such as washing hands, utensils, &c. - -Quicklime is the cheapest and the most easily procurable disinfectant -for drains and for disinfection of discharges. Carbolic powder made by -adding carbolic acid to lime is very useful for the disinfection of -public latrines, drains and sewers. Corrosive sublimate, in the -proportion of 1 part in 4,000, is the most efficient germicide known and -should be used diluted with water for sprinkling on public roads and for -flushing drains and washing latrines, &c. It is, however, poisonous and -corrodes metal drain pipes. In quarantine or isolation camp the latrines -should be of the dry earth system. Carbolic acid powder should be -largely used in them. The question of suitable disposal of sewage -depends on the circumstances of each town or village, but incineration -is the most sanitary method during an epidemic. Other disinfectants too, -such as Jey’s Fluid, Creoline, Phenyle, Izal, Sanitas, may also be used. - - - - - Transcriber’s Notes - - -—Silently corrected a few typos. - -—Retained publication information from the printed edition: this eBook - is public-domain in the country of publication. - -—In the text versions only, text in italics is delimited by - _underscores_. - - - - - - - -End of the Project Gutenberg EBook of The Bubonic Plague, by A. 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