Evening bulletin. [volume] (Honolulu [Oahu, Hawaii]) 1895-1912, 1899-12-23


the disease. In fact, the symptoms
usually are so urgent that in an hour
or two the patient appears as IL he had
been i'll for a week. The temperature
may suddenly rise to 104 degrees F.
or more, or it may reach its maximum
only after two or three days. an many
cases it never rises above 101 degrees
f., and IL may fall to normal after a
day or two. The increase of tempera-
ture is no guide to the virulence or
the invasion period is usually full anu
feeble and irregular.
LYMtHATIC SYSTEM.
The rapidity with which buboes APP
pear is at times amazing. and they as
sumo huge size In q few hours or on
the other hand, may continue of mod
crate size twalnuD through the ill
ness.
DIGESTIVE SYSTEM.
Early in the disease the lips become
dry and cracked; the dorsum of the
tongue is covered by thick, greyish-
white fur, which speedily changes to
mahogany or almost black crust,
whilst the tips and edges appear alb
normally red. The appetite is lost
vomiting of watery bile-stained fluid,
or of coffee-ground looking substances,
occurs irregularly throughout the ILL
ness Constipation may rule. or may
alternate with loose objections with or
without blood. The spleen is always,
and the liver usually, enlarged; but
owing to the apathetic state of the pa
tient it is not always possible to elicit
an expression of pain during examine
ton of these organs.
The nervous symptoms in plague
may from the first assume a wild de-
| lirious form. Unless the patient is
watched he may rush to the window or
verandah, or into the street. The ac-
ton is, however, a mere wandering
of the mind" and not q distinct effort
of the will. Instead of active delirium,
the patient may be apathetic, listless,
eXpressionless, or semi-conscious from
the first, needing no one, and answer
ing questions only when partially
reused. In children, muscular twitch.
ings and commissions are common.
Death may occur in twenty-foui
hours, but the third of fourth day IL
the most fatal period. Should the pa.
tient survive the sixth day, there are
hopes of his recovery.
DIAGNOSIS.
| A perusal of the several varieties in
the type of plague will serve IT, eluci-
date the fact that mistakes in diagno-
sis are possible. The absence of bu-
boes cannot be relied on as evidence
that the disease is not plague. On the
other hand, the writer sent a patient
suffering from high fever, vomiting
delirium, and acutely enlarged and
painful groin glands to the plague hos
pital in the belief that he was suffer
ing from plague, to find afterwards
that his symptoms were due To an at
tack of tilarial fever. 1t Is only by the
microscope and meteorological inves-
legations that precise diagnosis OF
plague can be arrived at in doubtful
cases.
GENERAL SANITARY MEASURES
The rat-All observers agree that
the rat is early infected by plague dur.
ing an epidemic. Many contend that
the rat Is infected before man, and that
the appearance of dead rats about a
house forebodes the illness of the in
habitaDts. Such being the case, II
would appear that the rat is the host
by which the plague is conveyed tC
human beings. The faces and urine
OF plague infected animals contain the
bacillus pests, and there can he nc
doubt but that the dejecta of these
Infected animals, getting into human
food. is sufficient to convey the dis
ease. Again, a decomposing rat, deat
OF plague, will be assalled by hosts O
insects, which shus become infecte,
themselves or serve to convey infect
ing media on their bodies and limbs
Such being the case. 1t would seem ad
yisable, nay impertiye, that, as a pro
phylactic measure, the rats in a plagu
threatened community outght to be de
stroyed before the advent Of the dis
ease Stamping out an epidemic O
plague is an irksome, tedious, and vel
, nigh impossible task. When playa
, comes 1t comes ito stay" and its IL
cursion ought to be warded off at al
hazards. Recently Manson, Simpson
and other authorities, declared that tn
only prophylactic measure to be re
lied upon Is the destruction of the rat
which infest ships, grain, sewers
, drains and Easements.
Segregation, isolation ad dlsinfec
ton are the means adopted by sanitar
authorities in every part of the worl
when plague breaks out in commun
ity. The moment plague occurs |
, any dwelling the patient should be re
, moved from the house to a special
constructed hospital. 1t Is advisabl
, that this hospital should be built {
temporary" materials merely, so ths
1t can be burnt when the epidemic
over or when 1t has become foul frol
long use. The hospital should be jus
/ outside the town In some isolate
piece of ground, but. II the city
large, 1t is unwise to have the hospiti
too far removed from the infecte
/ area, otherwise patients may suffe
| Ill effects nv having 10 no conveyed