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patient should be kept absolutely at rest in bed, from the commencement of the
fever. He should not be allowed to get oat of bed for any purpose, and hence the
use of the bed-pan and urine bottle should be insisted on.
Many persons not knowing the importance of absolute rest in such cases used to
shift the patient from one place to another for fear of his being detected and removed
to a Hospital. But it should be borne in mind that the fatigue of physical exertion
caused by such stealthy shifting from place to place is very great and disastrous
in effect.
The next point in connection with the maintenance of the patient's strength is
the regulation of food and drink given to him. In acute cases, rice and sago conjee,
milk, tea, and fruits were given. The food should be of the bland and most diges-
tible and nourishing character. It should be given in small quantity and at stated
intervals, irrespective of the desires or the inclination of the patients in the matter.
In treating Hindu patients, main reliance had to be put on milk as the most nourish-
ing article of diet. During the acute stage all meat preparations were prohibited on
principle, though they could be used in persons of certain caste who had no religious
objection to their use. They were used after the acute stage had passed according
to the necessity of each case.
It has been assumed by many practitioners that milk may be given ad-libitum as-
much as the patient can take without bad effects. But it should be remembered that
injection (taking in) and digestion are very different things. The physician should
satisfy himself that the milk in the quantity taken by the patient is being digested by
him and is not producing any bad effects by way of restlessness, flatulence, &c.
To convalescents, ordinary diet consisting of rice, dal, ghee, vegetable and milk
was given if his caste prejudices admitted of this.
As regards drink.—The patients were allowed to have a reasonable quantity of
barley water, soda water or if they -objected to it, pure water. If the thirst was ex-
cessive ice was given to suck,
Stimulants and cardiac tonics.—The heart seems to be very early affected in
this disease as indicated by the weakness of the first sound, and the pulse being
small, frequent soft and wanting in tone.
As general muscular relaxation and nervous exhaustion were prominent features
of the plague, the condition of the heart required a careful watch from the very
commencement of the fever, for the cause of death in the majority of cases was
failure of the heart.
This circumstance calls for an early administration of stimulants and cardiac
tonics in addition to the other measures taken to support the strength.
The stimulants and cardiac tonics used in the hospital were chiefly Ammonii
carbonas, ether, cinchona, digitalis, strophanthus, nux-vomica, and alcohol in the
form of rum or spirit Vim Gallici. Rum was used freely with medicine as well as
with milk. When the patient was found to be very low and the stimulants given
internally by the mouth were not likely to be absorbed into the system and prove
effective, strychnia was used hypodermically as the best stimulant,
As many patients admitted in the hospital were in the advanced stage of the
disease, the administration of stimulants by the mouth was not much depended upon,
and so strychnia was injected twice or even thrice a day in some cases. It may be
noted here that plague patients can tolerate proportionately large doses of strychnia
and liq. hydrargyri perchloridi, and it might be true also of other drugs.