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Whan swallowing is difficult and the patient refuses,everything by the mouth
the mixtures and feeding are given per rectum every three hours in double doses, or
nasal feeding is resorted to.
Hypodermic medication is resorted to in all true plague-cases and m. ii. of
Liq. Strychnia, and m. x. of ether are injected regularly every four hours, day and
night, with due precaution for rigidity of the muscles and high temperatures. In
serious cases the above is repeated every two hours with minim doses of Liq.
Strychnia.
Treatment of Complications.
Delirium is combated with ice-cold douching every two or three hours and occa-
sionally Bromide is given guardedly by the mouth or per rectum. In sleeplessness
half a dose of the sleeping-draught containing a little Bromide and Brandy is
administered and repeated if necessary; but in the majority of cases, a simple ice-
cold douche on the head for about 10 minutes proves equally serviceable. In
hyperpyrexia the patient is wrapped in a full pack of iced-sheets and the same cold
treatment resorted to in delirium is given to the patient. In very extreme cases,
however, ice-rubbing on the spine and on the nape of the neck is indispensable.
In bad cases suffering from Hiccough an extra ice bag is resorted to on the pit of
the stomach, and anything tending to increase the spasmodic contraction is
omitted; a minim dose of Belladonna along with a little Ether or Brandy is pushed
on every hour. When a patient is found in a very low condition, the external
application of dry heat to the extremities and sinapism on the chest and diffusible
stimulants are freely administered; the two-hourly hypodermic injections of Ether
and Strychina are persevered in.
Vomiting in milder cases necessitates the placing of an ice-bag on the epigas-
trium, and the total suspension of all food by the mouth except a little ice-cold conjee,
sometimes a little subnitrate of Bismuth is mixed with Bicarbonate of Soda and
given; whilst Salol too is at times not less useful. In persistent cases Ammonia and
Ether are entirely omitted from the mixtures and Mist. Pepsine Co., (Hewlett's)
given instead with due caution. The same preparation is also very useful in
severe cases of Diarrhœa, provided the pulse-condition of the patient in either case
allows the free use of it, and in such cases of Diarrhœa also, Bismuth and Salol is
given either by the mouth or per rectum as needed. Much care is also taken
absolutely to suspend the administration of milk. In extreme constipation, on the
other hand, a warm-water enema, with sometimes even a little Ammonium Chloride
is given once a day; but when this is found to be ineffective, Glycerine and Castor-
oil in dram doses are injected per rectum with a little conjee. When this condition is
accompanied with a considerable distension of the abdomen, Tr. Assafœtida is used
for external and internal medication with great efficacy, and ice-cold compresses at
the same time are placed on the abdominal wall.
Retention of urine is relieved as far as possible either by placing cold compresses
on the pubes or by emptying the lower-bowel by enema, &c.; hence the catheter is
resorted to only later on.
The commonest cutaneous affection is the bedsore; this is cleaned with Iodine
Lotion and an ointment composed of Iodoform, Hazeline and Lanoline applied to
it on lint. The abscesses that sometimes follow the hypodermic injection of Ether
are dressed antiseptically or cauterized with Nitrate of Silver when necessary.
In Pneumonic-plague, the abovementioned treatment is adopted; no hot
poultices or jacket-poultices are used; but ice-bags and cold are externally applied
to the chest wall.