104
the suppuration of a bubo was a favourable sign in so far that its suppuration
did not bring about a cure, since, if a patient live to this point, it is in consequence
of other reasons, but it was a more satisfactory ending to the local lesion than
a protracted resolution or persistent induration. Its approaching suppuration,
however, gave confidence to those attacked, their idea being that the whole mischief
was confined to the gland, and with this ending the disease subsided. It helped them
with courage to maintain a cheerful disposition when the acute symptoms had
passed and the remainder of the prognosis depended on their physical vitality to
resist the debilitating and atonising influence of the disease, or septicæmia.
As regards the effect of medicine, it cannot be stated with satisfaction that we
possess any standard remedies of certainty. What might seemingly cure one
patient is ineffective in another of the same type, and it is questionable whether the
successes shown are not wholly due to scientific nursing and hygienic surroundings
of a superior nature and to personal comfort and healthy ventilation. This, of course,
was impossible during the "opposition period" of the epidemic, when a large
percentage of patients were permitted to remain where they fell ill, in low, dark, over-
crowded ill-ventilated rooms, without proper food, or probably no food at all, and
absolutely unsupported by the administration of alcoholic stimulants.
The first success was a case at Mandvi. The patient had a bubo in the left
inguinal region, a temperature of 105, and all the other characteristics of plague.
He was cured in his own house ; his friends were well off and provided him with
a liberal supply of good milk.
A mixture composed of—
Sodii salici.
Liq hydrarg perch.
Spirit ætheris nit.
Tinct digitalis...
Rum ... ...
Water ... ...
...
...
grs.
dr.
dr.
m.
oz.
oz.
51
½
½
5
½
1½
every three hours.
He had 6 drs of magnesia sulphur previously, and it operated frequently.
The bubo was painted for the first few days with iodine liniment, and as the
skin became sore, constant hot fomentations were substituted. The object of the
above prescription was first that the sodii salic. acted as a diaphoretic and antipy-
retic, digitalis was inserted both as a cardiac tonic and to counteract any depress-
ing effect which the sodii might cause. The nitre was also given to encourage
the secretions, and rum for its stimulating qualities. At the end of three weeks
the man was quite well. The bubo terminated by resolution and not. suppuration.
The mercury was added for its alterative and antiseptic qualities or properties
under the idea that some poison would be
neutralized.
Several other patients treated similarly experienced no benefit and died.
The internal use of permanganate of potash promised favourable results, while
guiacol was applied externally ; the end was as above unsatisfactory.
The next change included strychnine owing to the strain of nervous disturb-
ance on the heart, and it has proved a valuable drug, which can be tolerated
in comparatively large doses ; indeed 5 or 10 minims given every four hours for
several days induced no twitchings or tetanic symptoms ; it was therefore added to
the first mixture. At this stage carbolic acid was introduced. Some preferred it.
in the form of sulpho-carbolates, but I used the acid instead. its modus operandi