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many times has it occurred that the patient has tumbled over dead whilst
getting up to stool, &c., that this is an imperative measure to insist upon.
MEDICINAL TREATMENT.
Purgation.—When the patient is first seen, the foul state of the
tongue, the foul breath, the jaundiced tinge of the conjunctivæ, and a
generally bilious aspect, suggests a purge. For this purpose, calomel in
5-grain to 10-grain doses recommends itself. This is to be followed by
a saline in some five hours' time. Against this treatment it may be
argued that the drain upon the system and the lowering action of calomel
are deleterious, but, if given quite early in the disease and not when the
pulse is flagging, it undoubtedly seems to do good. It frequently stops
vomiting, which is often present ; it clears away the jaundiced aspect,
it restores the power of taking nourishment, and it seems to diminish
mental aberration and cardiac distress. If a full gall-bladder justifies
the exhibition of calomel, post-mortem evidence of that condition is not
wanting. So far as is known, bacilli of plague escape from the body
in greatest numbers by the bowel. In the breath, sweat or urine, bacilli
are but sparsely met with, but in the fæces a rich supply is found. This
points to the necessity of ample disinfection as being requisite for all
latrines, bedpans, closets, &c., but it also proclaims as justifiable and
rational the attempt to assist nature in expelling the poison of plague by
a free action of the bowels.
Stimulation.—From the very first onset, or certainly after twenty-four
or forty-eight hours, it will be found necessary to stimulate the plague
patient by food, by alcohol, or by medicine.
Food.—Unless the patient is actually delirious, there is not usually
much difficulty in feeding plague patients. In fact, in comparison with
allied ailments, appetite is wonderfully good. One encourages this in a
general way, but the occurrence of sudden death supervening after the
ingestion of a full bowl of rice, for example, and its accompaniments, in
the case of Chinese patients on several occasions, leads one to the belief
that a full meal is not without its danger. The heart is in such a condi-
tion that it takes but little to disconcert its rhythm, and the pressure
consequent upon a full stomach is calculated to do this. Food should be
in small quantities frequently repeated and of a kind which is easily
digested. Brand's essence of beef, in fluid or jelly form, is excellent,
but any beef jelly will do. Ox-tail soup, mutton broth, beef and chicken
tea should be constantly 011 hand to suit the varying palate of the patient.
Conjee water—that is, the water in which rice is boiled—is useful as a
drink and serves as nourishment. Milk with ice (sipped slowly) and ice
cream (Lowson) are particularly grateful.
Drink.—Thirst is at times a marked symptom, and its relief should
be attended to by allowing the patient anything in reason. Ice to
suck, if not kept up too long ; water or lemon and water (not lemonade)
to drink, if not in such quantity as to distend the stomach ; beer and
stout iced, especially for Europeans, is " at once stimulant, soporific,
nutritious and thirst-quenching " (Lowson). Brandy or whisky diluted
with not more than three or four times its quantity of water (not aerated
waters) should be freely supplied. When the pulse shows signs of
failing or collapse or faintness supervenes, then, of course, alcohol is
doubly beneficial, and brandy is preferable to whisky as a cardiac
stimulant.