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observed that it extended for 21 days. A woman was admitted in the observation
ward who showed a continuous fever chart, but to my great surprise she complained
of pain in the sublingual region on the 21st day and developed a bubo, which sup-
purated, patient grew worse and ultimately died. It is doubtful whether in this case
the incubation period extended over 21 days or she caught the poison in the ward
from some other patient under observation.
Treatment.—The treatment of plague cases followed in this hospital is of two
kinds. The European system and the Native system of treatment.
European system.—Plague is such a fell disease that no drug has yet establish-
ed its claim for being a specific or something near it in the case of well-developed
plague cases. Drugs are no doubt of considerable value, but their value is limited.
They have shown by their actions how their uses vary and how the system under
the influence of plague poison could tolerate enormous, even actual, poisonous doses
of certain drugs.
The line of treatment adopted in this hospital is as follows:—
No sooner is the patient brought to the ward, than he is put on a cot, having
for his bedding a kumbly, a white sheet and a blanket to cover. A piece of mackin-
tosh is placed over the bed and the patient is made to lie down on it. He is then
washed with a carbolic acid lotion diluted. All his clothings are burnt, and he is
given hospital clothing. He is then gi-ven a dose of stimulant mixture and four
ounces of milk. The further treatment of the case is more or less symptomatic. (1)
To control the febrile state, Diaphoretics or Antipyretics are not used to bring down
the temperature as they have a deleterious influence on the heart, and have been found
to do more harm than good. Reliance is therefore placed on the application of hot or
cold pack and ice to the head to bring down the temperature Continuous sponging
brings down the temperature, but only for a short time. Patients in thia hospital
prefer hot pack, and I believe it is an efficient measure of controlling the temperature.
(2) To control delirium Bromide of Potassium and Hyoscyamus is usually persisted
in the acute cases, but when the patient is very violent resort is to be had in subcu-
taneous injection of Hyoscine. It works efficiently but is a strong depressant and
care must be taken to stimulate the patient after the injection.
Ice bag to the head is of very little use as the patient does not keep quiet and
tears the bag into pieces. In low muttering delirium, stimulants are of great value.
To support the heart's action, a mixture of Ammonia Carbonas, Strychnia, Digitalis,
Caffeine Citras and Rum is continued every four hours day and night. But when the
patient is quite unconscious or not able to swallow-and the heart is failing, he is given
two hourly injections of Strychnia, Strophanthus and Rum.
To control diarrhoea, an astringent mixture or Dermatol is generally resorted
to but these have no effect; an astringent enema is tried and succeeds in many
cases.
To control haemorrhage from the lungs, stomach or intestines, more reliance is
placed on Calcium Chloride than Hazeline and other astringents.
To control plague poison itself several drugs in various combinations have
been tried without any satisfactory results. Liquor Hydrargyri Perchloride in one
drachm doses was once said to have wonderful effect in controlling the plague
poison, and was given a long trial in this hospital, but it proved to be of little value
Similarly, Liquor Hydrarg. Perehl, and Carbolic Acid in one minim doses, then
a combination of Tinct. Iodi, Acid Carbolic, Liquor Strychnia and Glycerine were
tried, but the results were in no way encouraging. A mixture of Liauor Hydrarg.
Perchl, and Pot. lodid. which is supposed to form an efficient germicide, was tried