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Stimulation by hypodermic injection of ether is a treatment that
gives grateful response, and must be used freely and frequently. The
collapse from plague does not take place at that period of the disease
when organic structures are played out, but it occurs early in the
disease, in two or three days, and is therefore more of a functional or
toxic than of an organic nature; consequently, the use of stimulants,
in whatever form, is more likely to be attended by remedial results and
not by a mere temporary flicker of response.
Internally, the form of drug most useful is either a general stimulant,
such as ammonia, or a cardiac tonic or specific.
The prescription of every practitioner who treats plague will be
found to be one in which carbonate of ammonia and the tincture or
decoction of cinchona are met with, and with. this mixture now given,
now withheld, will be exhibited digitalis, strophanthus, or camphor.
More good is ascribable to ammonia in some form than to any other
known and more specific drug.
Digitalis in infusion, tincture or in leaf—the latter perhaps the best
—seems the one drug called for when the pulse becomes dicrotic and
the nervous stimulation of the heart gives out. In practice, however,
it is unsatisfactory, and seldom can any good results be traced to its
administration. No doubt, the slowness of its action is against it; but,
what is still more, positive evidence is against its being considered a
reliable drug in an acute illness like plague.
Strophanthus is in the same category with digitalis.
Camphor in its double action as a direct cardiac stimulant and a
stomachic carminative is useful as an alternative drug. Undoubtedly
the best form is in pill in doses of gr. ij. Camphor may advantage-
ously be used hypodermically dissolved in sterilised oil. Caffeine also
is worthy of trial.
Musk, in the few cases treated therewith, seems to justify its
administration, and it is a form of circulatory stimulant which one wel-
comes as an addition to one's resources. The musk, as fresh as can be
obtained, may be given in 5-grain doses every six hours as an expedient.
Strychnine, administered by the mouth or hypodermically, is of the
greatest use, Granted that a functional abeyance of the nervous in-
fluence, more especially of the heart., is the cssenco of the toxic effect of
the plague bacillus, strychnine ought to bo a drug of importance in the
treatment. This expectation was borne out in practice, and Dr. Lowson.
in his report, and all who have reported on the treatment of plague,
regard strychnine as a most reliable agent in the form of stimulation,
required in plague. Liquor strychnines in 5 to 10 minim doses, given
every four hours, is the most convenient form; but when vomiting is
present, a hypodermic solution of gr. \1/48\ of the sulphate of strychnine
in 10 minims of distilled water is advisable.
Other drugs may be mentioned, but, though useful as a change and
a stand-bye on occasions, they do not justify more than a passing
notice. Among the more important are quinine when malaria compli-
cates the disease, as evidenced by a largo spleen; aconite in the early
stages, when high fever and a full pulse are present; chloride of
ammonium as an alternative is occasionally useful.
The inhalation of oxygen (Lowson) is not to be neglected, and the
gas ought to be always at hand and ready for immediate use,