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Delirium.—When active the delirium of plague is best combated by
cold to the head. Leiter's coil would be perhaps the readiest method,
provided the patient could be kept still, but an ice-bag or a constantly-
wetted cloth is efficient. These applications combined with tepid spong-
ing of the body at frequent intervals seem grateful to the patient, are
useful means of reducing temperature, and seem the safest and readiest
method of quietening active delirium.
Hyoscine.—In most cases, but not in all, hyoscine administered
hypodermically in doses of gr. \1/100\ is perhaps the most efficient and safe
of the hypnotics. It calms the nervous system and induces sleep when
everything else fails. Hyoscine should be one of the first drugs in the
armamentarium of a plague hospital.
Morphine.—At times nothing but morphine administered hypodermic-
ally in doses of gr. \1/8\ to ¼ is of any avail. A priori one would not
select it as a hypnotic or anodyne, but experience has proved it to be
reliable, and not so unsafe as to exclude its use. It is almost certain
that, when painful adenitis complicates the cerebral intoxication, mor-
phine effects its purpose. The safest method of administration is in
combination with atropine.
Bromide of Potassium.—An occasional dose of bromide of potassium
during delirium is useful and without danger, but its prolonged use is
not permissible.
Diarrhoea.—An occasional looseness should not be stopped unless it
continues over twelve hours and the patient seems exhausted thereby.
It is but seldom obstinate and yields to salol in gr. x doses, or to an
enema of starch and opium ; or, still better, a suppository of morphine
and cocaine, gr. ¼ and gr. ½ respectively, more especially when continued
straining persists (Lowson).
Vomiting frequently ushers in an attack of plague, and may persist
throughout the illness. When the latter condition obtains, it is an
unfavourable sign, as loss of strength ensues owing to the rejection of
food and medicines. A mustard plaster to the epigastrium, ice to suck,
and an effervescent draught of a few drops of hydrocyanic acid and
liquor morphiæ are generally sufficient to check this untoward symptom
(Lowson).
Pyrexia, no doubt, accounts for some of the delirium, the restlessness,
the headache and subsequent collapse. Hyperpyrexia is exceptional.
The usual chemical antipyretics, antipyrin and phenacetin, are such
severe depressants that they are at a discount and should not be used.
Should hyperpyrexia necessitate its use, one hypodermic of antipyrin
is, no doubt, justifiable, but only as a last resource. Frequent sponging
with tepid water, ice to the head and nape of the neck, iced drinks, and
a short application of the wet pack, with the administration of brandy by
the mouth or by the rectum, are useful when promptly and rationally
used.
Stimulants, Externally.—Flying blisters of mustard to the limbs,
abdomen and over the heart are useful. Smelling-salts and strong
ammonia applied to the nostrils often succeed in restoring the pulse,
rousing the patient in collapse, and not infrequently cause him to rally
from what seems a moribund state (Lowson). Nor is this kind of
stimulation of mere passing effect, for in several instances when death
seemed inevitable and at hand, patients have revived and actually
recovered permanently.