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first notes on the case. The nurse's later notes were usually taken 45 minutes after
the earlier notes. They were given to me at the end of the day, and appended to my
own notes. Some sphygmograms were also taken, but were soon given up.
Sixty Charts dealing with fifty-one patients have been prepared [the small num-
bers represent time in minutes, respiration in red, pulse blue, and temperature black.
The temperatures are only those before and after the bath].
These observations were made with a view to learning whether various types of
plague cases, acted in uniform or characteristic manner ; whether any prognostic
points could be established and whether any indications for treatment might be made
out. The results are largely negative.
The Charts lettered B have to do with the question of what happens to the pulse
and respiration immediately before and after and during the- Bath. As to what
happens an hour or more after the bath, I have nothing definite to state, as apparently
no two cases acted alike, and the return to the condition existing before a bath was
given was never a process allowing of the formation of any rule.
These Charts by themselves do not shew much, but when taken in conjunction
with the experience of the whole bulk of the Bath cases, a few points may be made
out. These points, however, have never been disputed and are not new; the results
here shown merely confirm their truth :—
(1) Of all the successful cases the majority are those in which neither
the pulse rate nor the respiratory rate are very high.
(2) Whenever condition (1) holds good, then should the changes in
pulse and respiration go hand in hand, that is, should the red and blue
lines be approximately parallel, then the case usually does well.
(3) That of all bad conditions, a high pulse rate, especially if the tension
be also low, is the worst.
(4) A high respiration rate with pulse rate, which is nevertheless not
much accelerated, is not particularly unfavourable. (Cases No. 385
and 673 do not appear to agree with these statements.)
These statements after all merely amount to saying that of all complications
cardiac complications are the most serious ; that if the circulation and respiration
go on in htarmony, the case is favourable, two very important functions not being
much disturbed. I think slight pulmonary troubles do not centra-indicate the Bath.
When a patient has a bath, the pulse and respiration shew the following-
changes. The combined changes are of more importance than the changes occurring
in either of them alone ; for that reason the following description refers to the two
functions together. 'cr
Unless very rapid at the beginning, the pulse rate is increased and the tension
slightly 'raised ; about two minutes later the rate is still further increased as also is
the tension ; then rather suddenly the latter markedly drops, and the volume and
rate increase. These- changes are preceded by alterations in the respiration, consisting
of a gradual increase in rate but not in depth, to be broken by a sudden and mai'ked
increase in depth in the breathing. This increase in depth of respiration usually
occurs first after the sudden diminution in pulse volume referred to. Another
thing to be noted is that early in the respiratory changes, coughing frequently occurs
as if an effort is made to expel any mucus which may by chance esist in the air
passages. Quickly following on the respiratory and circulatory changes, we have
sweating, which usually is synchronous with the increased depth of breathing referred