NationalLibraryOfScotland/medical-history-of-british-india huggingface dataset:
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CASE·II.—BUBONIC PLAGUE.—RE-ABSORPTION OF BUBO WITHOUT
SUPPURATION ; RECOVERY.
Gownsbanker Mathara, a male Hindoo, aged 25 ; private servant ;
admitted March 2nd, 1898. There is a history of two days' illness, the
principal symptoms being headache and giddiness, fever and a swelling
in the right groin.
State on admission.—The patient is conscious and answers questions
rationally ; at times there is delirium ; there is severe frontal headache
and giddiness. The tongue is moist and covered with a thin white fur:
The conjunctiva are injected. There is a very tender bubo, the size of
a hen's egg, in the right femoral region. Temperature 1002°, pulse 96,
weak ; respirations 28.
Treatment.—Poultices to the bubo ; rest, milk diet, four ounces of
rum in the twenty-four hours ; and the Mist. Quin. cum Strych (vide
case I). On March 3rd, as the pulse became weaker the following hypo-
dermic injection was given and repeated every 4 hours :—
Liq. Strych. m. V.
Sp. Aetheris. Sulph. m. XV.
Course of the illness.—From the 3rd, improvement was rapid but
interrupted. The pulse became slower and stronger. Delirium was at
times troublesome, but was easily controlled by sujphonal. As the bubo
showed no signs of softening the poultices were stopped. The bubo
gradually receded, and on the day of discharge there was scarcely any
perceptible swelling. The patient left the hospital on March 26th,
CASE III.—BUBONIC PLAGUE.—SECONDARY PNEUMONIA AND PLEURISY ;
EXHAUSTION AND DEATH ON THE TWENTY-SECOND DAY,
J. F. Sequeira, Christian male, aged 20 ; admitted to hospital Feb-
ruary 24th, 1898, with a history of two days' illness.
State on admission.—Temperature 105°, respirations 38, pulse rapid
and weak. The tongue is coated with a thick, white, dry fur on the
dorsum, leaving a pink patch of normal mucous membrane at the tip.
There is a small tender bubo in the right groin. There is some cough
with scanty mucous expectoration. The chest is normal save that
medium crepitations accompany inspiration at the left base posteriorly.
Treatment.—Milk- diet ; four ounces of rum in the twenty-four
hours. Poultices to the bubo. The chest was wrapped in cotton-
121
wool and the following stimulant and expectorant mixture was pre-
scribed :—
R./
Ammon. Carb. grs. V.
Sp. Aetheris Sulph. m. XX.
Liq. Strychniaa m. V.
Sp. Chloroform m. X.
Aquæ Camplioris ad. oz. I.
every four hours.
Later, as the pulse became weak, hypodermic injections of
Strychnia and Aether were given every four hours.
Course of the illness.—The bubo rapidly increased in size until
it was as large as a turkey's egg ; a large and deep slough formed in-
volving the whole depth and breadth of the bubo, and when this
separated (on March 12th) a large, deep, irregular cavity was left, which
at no time showed much tendency to heal. On March 12th, there was
slight hæmoptysis ; pain was complained of in the left side and a dry
pleuritic rale was heard over the left base in the axilla. The temperature,
which had throughout been very irregular, dropping on many occasions
to normal and on others rising to 103° or 104°, rose on the 13th to 104·8°a
nd the sputum was for the first time rusty in character. On the 14th
the breath sounds on the left side were distant ; friction was absent ;
expiration was prolonged. On the 15th, the pneumonic signs were more
pronounced ; these were dulness, tubular breathing, and profuse fine
and medium crepitations. The pulse was at this time very weak. On
the 16th, the patient became delirious; there was profuse rusty sputum ;
the pulse became extremely weak and in spite of treatment death occurred
at 8 p.m.
CASE IV.—BUBONIC PLAGUE.—MULTIPLE SUPPURATING BUBOES; INTER-CURRENT
ERYSIPELAS ; EXHAUSTION AND DEATH ON THE BOTH DAY.
Joseph A. Dennis, Christian male, aged 25 ; cook; admitted to
Hospital February 21, 1898, with a history of three days' illness.
State on admission.— Temperature 100·6° ; pulse 98, intermittent ;
respirations 30. The tongue is moist and highly coated with greyish-
white fur ; there is nausea, but no vomiting ; the bowels are confined.
There is a tender bubo, the size of a walnut, in the left axilla ; there
is also pain and tenderness in the left neck, but no swelling can be felt
there. There is no cough and the chest is normal. The spleen is not
enlarged.
122
Treatment.—Rest ; milk diet. Four ounces of rum in the twenty-
four hours.
R./
01. Ricin oz, i statim.
Mist. Quin. C. Stiychinii oz. i (vide case I),
Every four hours.
Course of illness.—On February 24th, a chain of small hard, tender,
swollen glands was felt in the right neck, and along the anterior margin
of the sterno-mastoid ; and a very similar chain of glands appeared in
the left groin. On the same day there was some diarrhœa. There was
marked sleeplessness which required sulphonal to control it. Three
days later a chain of enlarged, tender glands appeared in the right groin,
both above and below Poupart's ligament, and a small tender swelling
was first noticed in the right neck. The temperature rose to 103° and
from that time until the 10th of March the temperature curve shows a
daily rise to a maximum varying between 100° and 103°.
On and after March 11th, the temperature remained normal until the
13th. A large furuncle appeared on the right shin on February 28th,
and was opened. The bubo in the left axilla was incised on March 6th,
and that in the left groin on March 7th. Both the cervical buboes were
opened on March 13th and about one drachm of thick pus was squeezed
out of each. The patient became markedly weaker in consequence of
the great drain of matter from so many different parts of the body, and
he was placed on a regimen of milk and sago conjee, egg-flip, six ounces
of rum in the twenty-four hours, and Brand's essence of beef.
On the evening of March 13th, the day on which cervical glands
were incised, the temperature rose suddenly to 105°, and there was pro-
fuse perspiration with marked prostration and weak pulse. After a
close of Phenacetin, gr. 15, the temperature fell to 98°. Hypodermic in-
jections of Strychnia and Aether were given every four hours. On the
14th a small sub-mental bubo was incised and 3 drachms pus squeezed
out. The temperature rose to 102·8° ; nothing could be discovered
either in the internal organs, or locally at the site of the incisions, to
account for these rises in temperature ; but on the 16th a red blush and
a certain amount of brawny swelling had appeared in the left neck,
starting from the clavicle and spreading upwards over the cheek.
The weakness increased and despite the exhibition of large doses of Tr.
Ferri Perchloride (m. 20 every four hours), the erysipelas spread to the
right neck and cheek. Constant and profuse perspirations, which were
only slightly checked by the liberal exhibition of Belladona, still further
exhausted the patient, and he died at 5-30 a.m. on March 20th.
123
It is of interest to note that in this case the enlarged glands in the
right groin completely receded, while all those in other positions (namely,
the right and left cervical, the sub-mental, the left axillary and left
inguinal) suppurated.
CASE V.—BUBONIC PLAGUE.—MULTIPLE BUBOES ; HYPERPYREXIA
DIAEEHOEA ; RECOVERY.
Shivram Vithoba, Hindoo male, aged 22 ; admitted to hospital
March 2nd, 1898, with a history of two days' illness.
State on admission.—Temperature 102·8°, pulse 130, very feeble ;
respirations 40. There is a small, hard, tender bubo in the left axilla,
and a small patch of necrosed skin on the anterior surface of the left
forearm. Between the left little and ring fingers is a small furuncle.
The tongue is moist and slightly furred. The bowels are regular.
There is no cough. The spleen is not enlarged. The mental state is
clear. At midnight the temperature rose to 105° and the patient
became delirious and restless.
Treatment.—Rest ; milk diet. Three ounces of rum in the twenty-
four hours. Poultices to the bubo.
R/ Mixt. Quinine cum Strychnia oz. I, every 4 hours.
and for the hyperpyrexia :
R./ Phenacetin gr. XV, statim.
Course of the illness.—The bubo in the left axilla slowly receded.
On March 8th a small tender bubo appeared in the left groin. On
March 10th a similar bubo appeared in the right axilla, and on the 11th
a fourth bubo was noted in the right neck, below the ear. The bubo
in the left groin was incised on the 13th and discharged freely.
Those in the axillæ and neck receded without suppuration. On
the 23rd the bubo in the left axilla, which had nearly disappeared,
became larger and painful but it again receded without suppuration.
On the 24th a very tender swelling of the left supra-trochlear gland
appeared and rapidly suppurated, and was opened on the 25th. In the
meantime the temperature had been constantly high, on two or three
occasions rising above 104°, but on the whole showing a tendency to
become lower. Exceedingly troublesome diarrhœa set in on March 4th
and lasted with, intermissions until the 10th. Between the 4th and the
15th the patient was extremely weak, and the prognosis at this time
seemed almost hopeless. He was placed on special diet, with egg-flip
and an increased quantity of rum, and Strychnia and Aether was injected
124
hypodermically every 4 hours. Improvement was slow but steady. The
buboes which had been opened gradually healed and the others completely
receded. The patient is now (April 7th), with the exception of some
remaining weakness, quite convalescent, and will shortly be discharged.
CASE VI.—BUBONIC PLAGUE.—LATE APPEARANCE OF PRIMARY BUBO (ON THE 8TH
DAY) ; BRONCHITIS ; DEATH ON THE 9TH DAY.
Philip Fernandez, Christian male, aged 46 ; a butler ; admitted to
Hospital March 15th, 1898, with a history of three days' illness.
State on admission,—Temperature 99·8°, pulse 102, fairly strong ;
respirations 24. The togue is thickly coated with grayish-white fur,
and dry. There is slight frontal headache and some giddiness. There
is some cough, most troublesome at night ; the expectoration is scanty
and muco-purulent. The bowels are confined. No bubo can be dis-
covered. There are sibilant ronchi on both lungs, otherwise the chest is
normal.
Treatment.—The patient was put in an observation ward, the chest
was wrapped in cotton wool ; he was ordered milk diet and the following
tonic and expectorant mixture :—
Ammon. Park. gr. V.
Vin. Ipecac, m. V.
Sp. Cloroformi. m. V.
Liq. Strychninge m. IV, oz. L
Aqua. Camph: ad. oz. I.
Every 4 hours.
Course of the illness.—The bronchitic symptoms showed little signs
of cleaning, and the patient became gradually weaker. On March 20th,
5 days after admission and on the 8th day of the illness, a small hard
tender bubo appeared under the chin. The weakness increased, the
bronchitic symptoms became more marked, loud crepitations, indication
of hypostatic conjestion appeared at both bases behind, and the patient
died of exhaustion at 11-45 a.m., on the 21st of March.
SIX CASES REPORTED BY DR. ALICE CORTHORN.
CASE I.—S. G., HINDU FEMALE, AET : 12 ; ADMITTED 12th MARCH 1898 AT 6 A.M.,
CONVULSIVE TYPE ; DEATH.
History.—Rigors, followed by five days' fever, attended for two
clays with diarrhœa and vomiting, some cough, and a tender painful
bubo in the right groin.
Condition on admission. —Temperature 100, pulse 87 per minute, and
respiration 32 : dry hot skin, moist furred tongue, headache and great
prostration.
125
Course.—Prostration increased and diarrhœa continued. She fell
out of bed apparently in a fit, for, when seen soon after, she was un-
conscious, with upturned eyes, shallow and rapid respiration, thready
pulse, and convulsive movements of upper limbs. There was also à
huge purple hæmatoma on the forehead. Consciousness never returned,
and at 3-15 p.m. she was lying with lower limbs stretched out, pupils '
dilated, and inactive to light, arms flexed and stiff, teeth clenched and
body opisthotonous. After two minutes the muscles relaxed and urine
was passed. Three fits followed with gradually diminishing intensity,
death occurring at 3-45 p.m.
Treatment.—Chalk mixture had been given for the diarrhœa and
rum for the prostration and one dose of a mixture containing Quinine
and three minims of Liquor Strychniæ.
CASE II.—SECONDRY PNEUMONIA ; DEATH.
E. K., Hindu female,aet. 19 ; admitted 14th March 1898 (afternoon).
History.—Rigors and fever of one day's duration.
Condition on admission.—Temperature 105, pulse 120 (fairly strong
and regalar), respiration 37; drowsiness, constipation, thickly furred
to ague, and diffuse tender swelling in the left groin above Poupart's
ligament.
Course.—Constipation continued, slept well with intervals of
excitement and delirium, pyrexia continued, pulse became weaker, tongue
somewhat clearer, drowsiness diminished, bubo extended to femoral
glands, sudden supervention on 19th March 1898 of acute pneumonia
followed by death on 20th March 1898 at 3-5 p.m.
Treatment.—Hypodermic injections of three minim doses of Liq.
Strych. every four hours, and a mixture containing Tinet. Nucis Yomic.,
Spirit Aether, Spirit Ammon., and rum. Constipation was relieved by
Calomel and enemata, and delirium by Pot. Brom. and Caffeine Citrat.
CASE III.— SUPPURATION OF BUBO ; RECOVERY.
M. V., Hindu female, aet. 20 ; admitted 4th March 1898.
History.—Fever of two days' duration.
Condition on Admission.—Temperature 105, pulse 100 (fairly full
and regular), skin hot and dry, and tongue thickly furred.
Course.—Pyrexia continued high for two days and then was brought
down by Phenacetin. The tongue remained thickly coated and the
ocular conjunctive injected ; speech was indistinct and on 5th March
126
1898 a small bubo appeared in the right groin, which became painful
and tender on the following day, accompanied by diffuse infiltration.
Till the 10th instant the temperature ranged between 99 and 103, and
after that remained practically normal. The general condition of the
patient remained fairly satisfactory throughout. Fluctuation was
detected in the bubo on the 16th; it was incised on the 17th ; discharge
ceased on the 20th. and the wound had healed on the 24th, the patient
being declared convalescent.
Treatment.—Phenacetin for pyrexia ; poulticing the bubo, fol-
lowed by Carbolic compress and incision ; tonic mixture containing
Quinine and Strychnine.
CASE IV.—RECOVERY ; RESOLUTION OF BUBO WITHOUT SUPPURATION.
I, G., Eurasian female, aet, 16 ; admitted morning of 27th Febru-
ary 1898.
History.—Frontal headache, on 25th February 1898 and 26th
February 1898, persistent vomiting, pain in right groin on 26th Febru-
ary 1898 with high temperature 105°. Dead rats had been found in
patient's room 8 days previously.
Condition on admission.—Temperature 103, pulse 126 (feeble),
tongue furred and moist, tenderness, but no swelling in right femoral
region, slight cough, and skin moist.
Course.—Vomiting persistent for two days (controlled by ice and
Sinapisim Epigastrium). Delirium and insomnia marked on 1st March
1898. Pyrexia continued for ten days, fluctuating between 100 and 104,
and once reaching 105. Temperature was normal on 13th March 1898.
On 2nd March 1898 there was retention of urine for 24 hours, necessitat-
ing passage of a catheter once. Bowels constipated up to 6th March
1898 followed by diarrhœa ; fulness over the tender region followed soon
after admission and developed into a bubo winch began to subside on
13th March 1898 ; poulticing caused a blister over the bubo resulting in
an indolent ulcer ; convalescence was steady and the patient was dis-
charged cured on 22nd March 1898.
Treatment.—Poulticing to bubo ; dressing to ulcer ; Calomel and
Castor Oil for constipation ; Sulphonal for insomnia ; Phenacetin and
Diaphoretics for fever ; Rum for prostration, with Ammonia, Ether and
Liquor Strychniæ ; tonic mixture containing Quinine and Strychnia
during convalescence,
127
CASE V.—MULTIPLE BUBOES ; DEATH.
P. D., Hindu female, act. 25 (ayah on duty in Hospital).
History.—Fever on 11th March 1898 with headache, vomiting,
restlessness, pain in calves of legs, and bubo in right axilla.
Condition on admission.—Temperature 101·4, pulse 98, respira-
tion SO, tongue furred, eyes injected, thick speech, drowsiness, only
partial consciousness, and bubo under border of right pectoralis major.
Course.—Temperature on 12th March 1898, 101, pulse 98,
respiration 30, tongue furred, eyes injected, and on 13th March 1898,
temperature fell to 97 at 6 a.m., with cold surface and extremities ;
on 14th March 1898 temperature rose to 101, surface still cold, bowels
much relaxed, speech more indistinct. On 15th March 1898 a bubo
appeared in the right posterior triangle of the neck; on 16th March
1898 the temperature rose to 103° surface still cold, low muttering
delirium, feeble thready pulse, respiration hurried and shallow.
A third bubo appeared under the chin and on 17th March 1898 she
became much worse, and one bubo appeared in each groin. She
gradually sank and died at noon of that day.
Treatment.—During first 36 hours she received 2 drachms a day, in
four-hourly doses, of Liquor Ferri Perchlor. On the first day diapho-
retics with Rum, Quinine and Strychnine, but after the second day these
were omitted, and a stimulant mixture containing Tinct. Nuc. Yomic.,
Spirit Aether and Ammonia was substituted.
CASE VI.—MILD FORM OF PLAGUE, COMPLICATED WITH GREAT MENTAL EXCITEMENT
DURING PERIOD OF ABATEMENT OF OTHER SYMPTOMS, RESOLUTION OF
BUBO WITH SUPPURATION.
0, R., Hindu female, aet. 40 ; admitted 2nd March 1898 ; fever and
swelling in the left groin having come on the same day.
Condition on admission.—Temperature 102°, pulse 120, respiration
30 ; tongue thickly furred ; left femoral bubo ; constipation and head-
ache,
Course.—She progressed favourably, the temperature falling
to normal on 7th March 1898 and the tongue cleaning up. On the
forenoon of the 7th she became maniacal, violent, and unmanageable,
and had to be quieted by Morphia. On the following day she had the
same symptoms but less marked, and the condition remained much the
same with delusions until the 12th, when she became quite quiet and
rational, and from this date she commenced to convalesce, the bubo
getting gradually smaller. On 23rd March 1898 she was discharged
cured.
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Treatment.—Castor oil for the constipation ; Quinine, Strychnine,
Rum in a mixture, Bromide and Morphia for the excitement, and poultic-
ing for the bubo.
ARTHUR ROAD HOSPITAL.
Statistical and Clinical Record of Work from July 1st, 1897, to March
31st, 1898.
(By Dr. N. H. Choksey.)
MEDICAL OFFICERS :
Dr. N. H. Choksey, Chief Medical Officer.
„ F. H. Pearse.
„ D. S. Fräser.
Dr. Treasury walla.
„ P. B. Pilgonka.
This Municipal Hospital has remained open continuously since the
date of the last report in June 1897, for the reception of all infectious
diseases. In addition to Plague cases, there have been admitted
persons suffering from two other diseases, cholera and relapsing fever,
which have been epidemic during the period under report.
Some idea of the magnitude of the work can be obtained when
it is stated that the total number of patients admitted during the nine
months covered by this report was 4,121. The total accommodation
has been increased from 150 beds in June 1897, to 500 beds.
On the first of July 1897, there remained in hospital 41 patients,
and there were admitted during the period covering the report 4,121,
making the grand total of 4,162 patients.
The admissions were distributed amongst the following diseases :—
Plague
Relapsing Fever ...
Cholera ...
Small-Pox
Chicken-Pox
Measles ...
Mumps
Whooping Cough
Observation
Total...
... 1,917
... 929
... 225
... 39
... 52
... 24
... 2
... 4
... 929
... 4,121
The maximum number of patients in hospital on any single day
was 350. The Plague maximum was 200, that of relapsing fever 120,
and of observation cases 50.
129
The following table shows the admissions from the various
diseases, by months, from July to March :—
Names of Months.
1897.
July
August
September
October
...
...
November
December
1898.
February
Total
13
11
33
31
52
167
496
660
454
1,917
15
24
54
57
82
190
188
218
101
929
111
73
26
8
3
2
1
...
1
225
10
4
...
4
2
1
2
2
14
39
1
......
...
4
6
13
28
52
......
1
1.
10
5
4
3
24
....
2
...
...
...
2
...
......
...
4
...
...
...
4
73
74
128
140
146
166
112
Cl
29
929
222
186
242
241
286
546
810
958
630
4,121
Plague and Relapsing Fever.
It will be seen from the above table that although Plague had
considerably lessened in Bombay, it had not become quite extinct, and
that during the months of July, August, September and October three
epidemic diseases—Plague, relapsing fever and cholera—were running
concurrently. Cholera, however, almost vanished in early October,
but Plague and relapsing fever went on gathering strength and
virulence as they advanced. It is indeed strange that two such
dissimilar diseases, Plague and relapsing fever, should run together,
attain their maximum, and decline also just about the same time,
though not in equal proportion. For whereas relapsing fever has
all but disappeared by the middle of April, Plague still continues
to claim its victims weekly by hundreds. Both diseases present
this peculiarity that they are infectious ; but it is an undoubted
fact that relapsing fever is highly infectious and certainly more so
than Plague. But here the similarity ends. As against a normal
Plague mortality of about 74 per cent., the mortality from relapsing
fever is 18·51 per cent. Another curious feature that was observed
during the second Plague epidemic was the blending or mixing
of the poison of relapsing fever and Plague in the same patients,
sometimes the one intensifying the other, at others moderating its
severity. And what was still more striking in this dual infection
was the fact that it existed mostly in the weak and the under-fed,
the same class of patients that have shown themselves to be the most
susceptible to both infections. When Plague has prevailed extensively
amongst the better classes inhabiting this city, the curious feature of the
mixture of Plague and relapsing fever was observed only amongst
the lower.