13
shows the recoveries and deaths among Europeans and Eurasians at the different
periods of life, but the numbers arc too small to attach much value to their
analysis. It will be noticed however (Table III.) that while among natives
the lowest percentage of deaths to attacks occurred between the ages of 1 and
20 years, in Europeans and Eurasians it lay between the ages of 20 and 40
years ; also that between 20 and 40 years the percentage of deaths to attacks
was twice as high among natives (69.75%) as among Europeans and Eurasians
(34.21%).
It is impossible to give any definite prognosis with regard to individual
plague cases, as sometimes those that appear to be quito hopeless recover, while
others apparently much less severe die. The conditions regarded as most
unfavourable are the occurrence of the disease in its septicaemic form, or as
primary plague-pneumonia. Among cases in which buboes are found, those
where the buboes are situated in the cervical region appear to be more
unfavourable than those with buboes in the axilla or groin ; and cases with
multiple buboes are more unfavourable than those with single buboes. The
symptoms which are generally looked upon as unfavourable are the persistence
of severe and continuous vomiting, and the early appoarance of diarrhoea, the
early onset and continuance of violent delirium, or the setting in of coma.
The appearance of petechiae is generally believed to precede death, and
haemorrhages from the kidneys and bowels are considered very unfavourable.
Attacks occurring late in the epidemic, although often no less severe in
their onset (Chart XXVI.), run a milder course than those occurring at the
beginning of the outbreak.
Treatment.—NO specific remedy has up to the present been discovered for
the treatment of plague cases.
During the present epidemic two lines of treatment have been tried, the
one, hygienic and symptomatic, with the object of tiding the patient over a
certain period when, as in the case of the other specific fevers, experience has
shown that there is a natural tendency to recovery ; the other, the antitoxic
treatment, with the object of neutralizing by means of antitoxic serum the
virus produced by the microbe, and of preventing the growth of the bacillus
itself,
The hygienic and symptomatic treatment consists in economising, as far as
possible, the nervous and muscular energy of the patient by placing him under
the most favourable conditions and treating symptoms. With this object a
plague patient is put to bed at the onset of the disease, kept in the recumbent
posture (on account of the tendency which there is to fatal syncope) until con-
valescence is established, and supplied with suitable nourishment at short
intervals.
The symptoms which require special attention are those connected with the
nervous system and with the circulation. In the nervous system they are mainly
due to congestion of the nervous centres at the commencement of the attack,
followed by oedema towards its close, the former giving rise to fever, headache,
vomiting, insomnia and delirium, the latter to stupor and coma. These symptoms
are treated on general lines, i.e. the avoidance of light, the application of ice or
cold water to the head and surface of the body if the temperature continues high,
and the use of hypnotics and sedatives for sleeplessness and delirium.
In connection with the circulation the symptoms to be combatted are vaso-
motor paralysis and heart failure, the latter probably due partly to the direct
action of the toxic poison on the cardiac ganglia and partly to softening and
degeneration of the muscular wall of the heart. For these symptoms the use of
alcohol in some form is generally required after the first day ; in most cases also
the administration of drugs which act as cardiac tonics and vascular stimulants
such as ammonia, digitalis, strychnine, quinine, is found necessary. All drugs
which depress the heart and circulation should, as far as possible, be avoided.
The treatment of pneumonia, primary or secondary, calls for the free
administration of stimulants and of stimulating expectorants for the relief of
cough and dyspnoea, due to the accumulation of fluid in the bronchial
tubes,B