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NURSING.
In a hospital ward, during the first five days of illness, practically
two patients require an attendant to themselves if the utmost good
possible is to be done. A nurse must never let her patient out of sight
for a moment, be the patient asleep or awake. She cannot leave the
ward or room, without posting a deputy, for any purpose whatever.
No nurse should be on duty for more than eight hours at a time ; still
better is it to follow the four hours' " watches " kept at sea.
The number of nurses required may seem outrageous, but we
have in many illnesses a day and night nurse for private patients,
and no more is demanded in this the most fatal illness known. Of
course, plague comes in epidemics, and the number of nurses is limited,
no doubt ; but we must not lose sight of what is necessary in con-
sidering what is expedient. Shortly, it may be put that a liberal supply
of doctors and nurses is essential if the lives of the plague-stricken,
be they native or European, are to be saved.
Enough has been said as to the rapidity of the onset, the develop-
ment, and the fatality of plague, to make the importance of early treat-
ment in the disease and of the requisite promptness in its administration
understood. The symptoms and signs change so rapidly, and in such
varying succession, that no stereotyped line of treatment can be followed.
Now it is delirium which calls for relief, now cardiac distress, or vomit-
ing may supervene ; or an unexpected loss of pulse, or a collapse totally
without warning, may carry off the patient before any help is obtainable.
The much despised legend " Treat symptoms as they arise " is the maxim
in plague, and if the word " promptly " were added, the summary of
plague treatment is before us. The disease is caused by a bacillus, the
toxic effects of which upon the blood give rise to functional derange-
ments of possibly all organs, but most markedly of the nervous system,
central and peripheral. The poison is so acute that, with the exception
of the glandular inflammation, but little structural change is met with in
the more vital organs. The cardiac trouble which is so marked an
accompaniment of the disease is evidently a functional one and the result
of derangement of the nervous supply of the heart. This has constantly
to be borne in mind when the subject of drugs is dealt with.
GENERAL TREATMENT.
The essentials are free ventilation, a cool room (60° to 70° F.
where such is possible), a plentiful supply of hot and cold water, ice,
a sufficiency of servants, and, of course, all the appliances of a modern
hospital. Deaths are so frequent and so sudden that when the hospital
is large it is necessary to have men employed whose duty it is to remove,
to disinfect and to dispose of the dead.
Nothing should be allowed to leave the ward but to be disinfected.
Crockery and glass should be scalded. Fæces should be sprinkled with
quicklime ; bed and bedding if not burnt are to be disinfected by heat ;
the steam disinfector is well nigh essential. Scrupulous cleanliness of
the floor and bedsteads, obtained by washing with a disinfectant solution,
are of primary importance, and all doorways should be curtained by a
sheet wet with carbolic acid, Jeyes' or other reliable antiseptic.
The patient should not be allowed to get out of bed for any purpose,
but the use of the bedpan and urine bottle should be insisted on. So