192
survives, phlyetene goes on increasing still further, and may attain a size of even three
inches in diameter. The slough now begins to be detached at the circumference of
the phlyetene with the formation of much offensive greenish pus. The ulcer left
after the slongh has completely detached itself is also characteristic. It is perfectly
circular, the margins are indurated and raised, and the base which shows indolent or
no granulations is at a much lower level than the surrounding skin, so that the nicer
appears as if it has been punched out of the skin. The foetid discharge alters with
the appearance of healthy granulations, and becomes laudable pus. But the whole
process of repair is extremely slow, and the ulcer heals only after a considerable length
of time.
The plague phlyetene is liable to be confounded with plague blisters and boils
and other plogmonous and gangrenous infiltrations of the skin arising from secon-
dary infection through the circulatory system. These are, however, distinguished
from the phlyetene by the following signs :—
1. They make their appearance during the course of an attack of plague
and not at the beginning.
2. They may be situated anywhere on the skin, and bear no definite rela-
tion to the bubo.
3. They do not show the characteristic local reaction of a phlyetene.
Treatment.
No changes have been made in the stimulant line of treatment followed in the
previous year, except that atropine is now given as a routine course in every case of
plague admitted into the Hospital.
Atropine
Treatment.
The efficacy of this drug was first shown by Dr. Row in his experiments on lower
animals, the full details of which, with the interesting blood pressure charts, will be
found in the papers read by him before the Medical and Physical Society, Bombay.
The chief difficulty met with is to regulate the dose of atropine. For it is some-
times found that while in some cases a very small dose of the alkaloid will suffice to
widely dilate the pupils, and cause all the symptoms of poisoning, in other cases a
dose of even three times the quantity will produce absolutely no effect.
Clinically I can confirm Dr. Bow's observation that plague buboes treated with
atropine show no signs of pus, and that when opened they show a mass of slouch
which cuts with a slightly gritty feel.
This fact alone is very interesting and important, and cannot be explained
except by supposing that atropine has a distinct antagonistic effect to the toxin
of plague.
It n s t i g' s
Sernm.
66 cases treated with Lustig's serum. A tabulated list of those will be seen
in the appendix.
Bacteriologi-
cal Examina-
tions.
In conclusion I have to thank Dr. Taylor for making bacteriological and micro-
scopical examinations of blood and sputa. In all 62 examinations were made, of
which 34 were blood samples, 25 agar cultures, and 3 blood serum capsules for test-
ing Widal's reaction for typhoid and Malta fever.
Observation
(Cases.
The total number of observation cases admitted was 830. These generally
turned out to be:—
Diarrhosa.
Dysentery.
Malarial Fevers.
;
Small-pox and Chicken-pox.
Pneumonia.
Beri-beri.
D. A. TITRKHUD, M.B., C.M., EDIN.,
Chief Medical Officer,
Modikhana Hospital.