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attention. Insomnia is often difficult to overcome ; and may be treated by chloral
bromides and Opium, but with great caution, as the former adds to the cardiac
depression, and the latter must be avoided if there is any tendency to coma, pulmonary
obstruction, or suppression of urine. Sulphonal, tehonal, and urethone are useful.
The ice-bag and evaporating lotions are often effective, and in coma vigil, liberal stimu-
lation must be used. If lung symptoms appear the treatment must be that usually
adopted in pneumonia. Vomiting can be controlled sometimes by sucking ice, minim
dose of vin. ipecac., and a mustard plaster over the epigastrium.
Treatment of Hyper-pyrexia.
Drug treatment is useless and harmful as the antipyretics are cardiac depressants.
Ice-bag to the head, cold sponging, or rubbing with ice, continuous cold packing
are the measures that have been most commonly adopted. The bath is objectionable
on account of the great disturbance to the patient. Every process of this kind requires
careful watching as the temperature sometimes runs down and collapse supervenes.
Diaphoretics and diuretics are useful in helping to carry off the toxic accumulations
in the blood and secretions.
The danger of sudden failure of the heart s action makes it imperativo to avoid
movement on the part of the patient as much as possible. Careful removal and change
of position by skilled hands and appliances can be done without much risk, and the great
difficulty is to prevent the patient from sitting up, or his friends from letting him do so.
To combat this tendency to fatal syncope alcoholic stimulants, ether subcutaneously,
amyl nitrite, coffee ammon carb, musk strychnin ; by mouth or subcutaneously are
administered together with cardiac tonics, strophanthus digitalis, convallaria, and
caffeine citras ; hot water bottles to the extremities and mustard plasters over the
epigastric and cardiac regions are useful. In the later stages of the disease it is
advisable to empty the bladder periodically with a soft catheter.
Local Treatment.
At a certain period of the epidemic when it was found that many of those cases
recovered in which suppuration of the glands took place, attempts were made to provide
an outlet for the virus at the site of the local inflammation, and so the buboes were
incised, canterised, branded or scarified, or leeches were applied. No improvement
resulted and the methods fell out of use. Some experiences show that it is actually
dangerous to the patient to incise or prick a bubo as the disease thereby becomes
generalized by direct infection of the blood, and no bubo should be touched with a
knife or capillary tube during the acute stage. In two mild cases morbid material was
taken from buboes by means of capillary tubes ; and in both instances the patients died,
the disease becoming quickly generalized! Injections into the substance of the glands
are open to the same objection, and solution of tincture iodi, acid carbolic, potas
permanganatis have been used for this purpose with doubtful effect.
The application of extract of belladonna, emplastrum hydrargyri poultices and
fomentations are useful to alleviate pain and tension. When the glands suppurate,
free incision, evacuation of the pus, and drainage, together with firm pressure are
followed by fairly rapid healing and with very little scar. As a rule and if properly
treated, the suppurating bubo of plague differs in this respect from the syphilitic
bubo, which is sluggish, unhealthy, and slow to heal.
The Special Methods of Treatment.
The special methods of treatment of plague are those of the prophylactic or
anti-microbic and the anti-toxin serum treatments, of which the chief exponents are
M. Haffkine, C.I.E., and Dr. Yersin.