48
food or what he requires may be brought to him by his friends and put down in an
appointed place from whence he can remove it and brief conversalion allowed at ten yards'
interval.
" 13. Besides this, the usual cleansing operations in the town should be carried out
vigorously.
" 14. Also the dead whenever practicable should be cremated. If buried, the grave
should be at lenst 6 feefc deep, the body covered with saw-dust and over this carbolic acid.
" 15. If the authorities of a town do all this to prevent plague spreading, it is clear
that they ought to be vigorously supported and that their efforts to keep the town free of
this disease ought not to be rendered futile by the opposition of purely selfish people who
have no care for the welfare of their fellow-townspeople, and I hope Government will be
able to see their \vay to effectively aid any town which has properly carried out the sanitary
measures as far as it rests with itself. Unless the people thoroughly understand tha't
Government intend, if necessary, to resort to forcible measures to carry out isolation, I fear
that the mofussil towns, now overcrowded with fugitives from Bombay living in badly-
ventilated houses, will suffer in proportion as much as Bombay."
B.
INSTRUCTIONS ΪΟΕ ASSISTANT-SURGEONS AND HOSPITAL ASSISTANTS.
DIAGNOSIS.
The symptoms of Plague in brief.
Plague is occurring in two forms - (a) \vith buboes, (δ) without buboes.
(a) With Buboes.—The onset of the attack is sudden, and there is often a rigor at first,
then fever comes on with bad headache, vomiting and frequently delirium. The fever
quickly rises high to 104° or more. The respirations are increased to 25, 30 or more, and
the pulse is rapid 100, or more, and soon becomes soft and compi'essible. The tongue is
either moist or a little dry, but not very dry or thickly coated with fur. (The condition of
the tongue and pulse is quite different from the furred tongue and full-bounding pulse usual
in ague). The patient feels ill and his face has an anxious expression, and soon pain is felt
in one arm-pit or groin, more rarely in the neck; within 24 hours a painful gLind can be
felt at the tender spot, and later a mass of glands can be seen and felt ? and the pain is
much more ; this is the bubo. The above description applies to severe cases; but there are
also milder cases in which all the symptoms are less, and the bubo is much smaller and less
painful, it may be only one somewhat enlarged gland. The liver and spleen are either
slightly or not at all enlarged.
(fc) Without Buboes.—These resemble bronchitis or pneumonia, and are usually fatal
within 3 or 4 days. The onset is sudden with rigor, fever, headache, &c., as above de-
scribed, and soon symptoms of bronchitis or pneumonia appear; but the symptoms in the
chest are slight and the patient is much more ill than he would be if he were suffering from
simple mild bronchitis or pneumonia. This is the diagnostic sign ; the man is much more
ill and his fever is much higher than can be explained by the amount of lung disease pre-
sent. The lymphatic glands are either normal or slightly enlarged, but there is no pain in
them and no bubo.
INSTRUCTIONS FOR TREATMENT, SEGREGATION, DISINFECTION, &c.
(1) Treatment.—There is no known certain treatment; many methods have been tried
in Bombay, but none with certain success. Among these are (a] local treatment of the
bubo by branding, blistering, leeches, incision, or injection of antiseptics such as carbolic,
acid, or tincture of iodine ; (δ) giving antiseptics internally, such as liquor hydrargyri,
perchloridi, sulphocarbolate of soda, carbolic acid, quinine ; (c) keeping the bowels well
open ; (d) cardiac stimulants, such as strychnine, caffeine, digitalis, ammonia, brandy, ether ;
(e) sedatives at night if required, bromide of potassium, chloral or opium. The value of (a)
and (&) is doubtful, but (c), (·?) and (e) are certainly of some use.
(2) Segregation of Patients.—The patients should be kept apart in a separate shed
reserved for plague (which can be burnt when the epidemic is over), with provision for
plenty of fresh air and ventilation. Overcrowding of patients is specially to be avoided.
Attendants do not easily catch the disease from a patient, but they should be careful to
wash after being with him. Any vomit, sputum, or excreta from a patient should be burnt
if possible ; if not, some disinfectant should be added to it, as phenyle, carbolic acid, chloride
of lime, or quicklime, and it should be buried. It is good to have an additional shed for
doubtful cases, in which a certain diagnosis has not betn made; but if not, they may be
placed in a reserved part of the plague-shed, and with but little fear of their contracting
the disease (supposing they have not already got it).
(3) Disinfection of Patients' belongings.—Whatever can be boiled or heated on a fire
may be thoroughly disinfected in this way. Things that cannot be so treated should be
freely sprinkled or washed with carbolic lotion (1 in 80) or phenyle, and be well exposed to
the sun and wind. Bedsteads and hospital equipment should be treated in the same way
after use,