MEDICAL ASPECTS OF PLAGUE.]
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delirium, or the setting in of coma. The appearance of petechiæ is generally believed to
precede death, and haemorrhages from the kidneys and bowels are considered very
unfavourable.
Attacks occurring late in the epidemic, although often no less severe in their onset
(Chart XXVÍ), run a milder course than those occurring at the beginning of the outbreak.
Treatment.—No specific remedy has up to the present been discovered for the treat-
aaeiat of plagíaos cases.
During the present epidemic two lines of treatment have been tried, the one, hygienic
and symptomatic, with the object of tiding the patient over a certain period, when, as in the
case of the other specific fevers, experience has shown that there is a natural tendency to
recovery ; the other, the antitoxic treatment, with the object of neutralizing by means of
antitoxic serum, the virus produced fey the microbe, and of preventing the growth of the
bacillus itself.
The hygienic and symptomatic treatment consists in economising, as far as possible, the
nervous and muscular energy of the patient by placing him under the most favourable
conditions and treating symptoms. With this object a plague patient is put to bed at the
onset of the disease, kept in the recumbent posture (on account of the tendency which there
is to fatal syncope) until convalesence is established, and supplied with suitable nourish-
ment at short intervals.
The symptoms which require special attention are those connected with the nervous
system and with the circulation. In the nervous system they are mainly due to congestion
of the nervous centres at the commencement of the attack, followed by oedema towards its
close, the former giving rise to fever, headache, vomiting, insomnia, and delirium, the
latter to stupor and coma. These symptoms are treated on general lines, i. e., the
avoidance of light, the application of ice or cold water to the head and surface of the body
if the temperature continues high, and the use of hypnotics and sedatives for sleeplessness
and delirium.
In connection with the circulation the symptoms to be combated are vasomotor
paralysis and heart failure, the latter probably due partly to the direct action of the
toxic poison on the cardiac ganglia and partly to softening and degeneration of the
muscular wall of the heart. For these symptoms the use of alcohol in some form is generally
required after the first day ; in most cases also the administration of drugs which act as
cardiac tonics and vascular stimulants, such as ammonia, digitalis, strychnine, quinine
is found necessary. All drugs which depress the heart and circulation should, as far as
possible, be avoided.
The treatment of pneumonia, primary or secondary, calls for the free administration of
stimulants and of stimulating expectorants for the relief of cough and dyspnæa, due to the
accumulation of fluid in the bronchial tubes.
Gastro-intestinal symptoms, buboes, and such other complications as arise are managed
on general principles.
In treatment by antitoxine the correct principle of removing the cause of the disease is
aimed at, but up to the present time, so far as information is obtainable of M. Yersin's
results, and those of other doctors, French and Russian, who have tried it, it has failed to
influence favourably the mortality among those attacked.
Surgeon-Captain Thomson, the Medical Officer in charge of Parel Plague Hospital,
supplies a tabular statement (vide Table VIII), showing the details of 27 cases under bis
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