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diff --git a/.gitattributes b/.gitattributes new file mode 100644 index 0000000..d7b82bc --- /dev/null +++ b/.gitattributes @@ -0,0 +1,4 @@ +*.txt text eol=lf +*.htm text eol=lf +*.html text eol=lf +*.md text eol=lf diff --git a/LICENSE.txt b/LICENSE.txt new file mode 100644 index 0000000..6312041 --- /dev/null +++ b/LICENSE.txt @@ -0,0 +1,11 @@ +This eBook, including all associated images, markup, improvements, +metadata, and any other content or labor, has been confirmed to be +in the PUBLIC DOMAIN IN THE UNITED STATES. + +Procedures for determining public domain status are described in +the "Copyright How-To" at https://www.gutenberg.org. + +No investigation has been made concerning possible copyrights in +jurisdictions other than the United States. Anyone seeking to utilize +this eBook outside of the United States should confirm copyright +status under the laws that apply to them. diff --git a/README.md b/README.md new file mode 100644 index 0000000..d807554 --- /dev/null +++ b/README.md @@ -0,0 +1,2 @@ +Project Gutenberg (https://www.gutenberg.org) public repository for +eBook #62931 (https://www.gutenberg.org/ebooks/62931) diff --git a/old/62931-0.txt b/old/62931-0.txt deleted file mode 100644 index 5c5a30b..0000000 --- a/old/62931-0.txt +++ /dev/null @@ -1,1677 +0,0 @@ -The Project Gutenberg EBook of The Bubonic Plague, by A. Mitra - -This eBook is for the use of anyone anywhere in the United States and most -other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms of -the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you'll have -to check the laws of the country where you are located before using this ebook. - -Title: The Bubonic Plague - -Author: A. Mitra - -Release Date: August 15, 2020 [EBook #62931] - -Language: English - -Character set encoding: UTF-8 - -*** START OF THIS PROJECT GUTENBERG EBOOK THE BUBONIC PLAGUE *** - - - - -Produced by deaurider, Stephen Hutcheson, and the Online -Distributed Proofreading Team at https://www.pgdp.net (This -file was produced from images generously made available -by The Internet Archive) - - - - - - - - - - THE BUBONIC PLAGUE. - - - BY - A. MITRA, L.R.C.P., L.R.C.S., F.C.S., - _Chief Medical Officer, Kashmir._ - - - Calcutta: - THACKER, SPINK AND CO., - 5 & 6, Government Place. - 1897. - - - - - CONTENTS. - - - Page - What is it? 1 - Its History 1 - The London Epidemic of 1865 3 - Geographical Distribution 8 - Causes 8 - Bacillus 9 - Contagious as well as Infectious 11 - Nature of an Epidemic 13 - Incubation 17 - Symptoms 17 - Varieties 21 - Diagnosis 21 - Prognosis 23 - Microscopic and Macroscopic Appearances 24 - Prevention 24 - Sanitary Measures by Municipal Authorities 26 - Private Hygiene 29 - Inoculation against Plague 32 - Treatment 33 - Treatment of Symptoms 38 - Disinfection 40 - Purification of a Room after Plague Cases 41 - - - - - THE BUBONIC PLAGUE. - - - - - _WHAT IS IT?_ - - -Any contagious and fatal epidemic disease was originally called a plague -(from _plaga_, a stroke), but this term is now applied to that -particular kind of plague which is characterised by the appearance of -high fever with inflammation of lymphatic glands or bubo, and is -therefore called the Bubonic Plague. In Sanskrit Medical Books it has -been described as _Vidradhi_ and _Visharpa_, and in Yonani as _Taoon_. -The following definition given by Cantlie is comprehensive. “Plague or -Malignant Polyadenites is an acute febrile disease of an intensely fatal -nature characterised by inflammation of the lymphatic glands, marked -cerebral and vascular disturbances, and by the presence of a specific -bacillus.” - - - - - _ITS HISTORY._ - - -It is an ancient disease mentioned in Hindoo and Christian Scriptures. -Long before the Christian era it prevailed in Greece, attacking the town -of Piræus, where it raged for two years. Egypt, Syria, Constantinople -and Rome were visited by the plague. In Constantinople the outbreak was -once so furious that during three months from 5,000 to 10,000 deaths -occurred daily. The first historical allusion to plague was made by -Rufus, a physician who lived in the reign of Trajan (A.D. 98-117), and -who mentions of glandular swellings. In 1347, plague appeared in almost -all countries in Europe, where Hecker believes, 25 millions of persons -perished. Ireland was visited by plague three hundred years after its -invasion by Patrolan, and it is said that 9,000 people died in a week -and were buried at Tallagh near Dublin—a name which means the burial -place of the plague-stricken. Plague visited England frequently, and no -fewer than eighteen epidemics are said to have occurred before the great -plague of 1665. In 1720, 40,000 out of a population of 90,000 died at -Marseilles. In 1751, 150,000 died of plague in Constantinople. In 1799 -the French Army in Syria was devastated by plague. 6,000 persons died in -Malta in 1813. In 1834-35, 14,888 persons died in Alexandria out of a -population of 42,000. In 1876 there was an outbreak of the disease at -Kumaon in Northern India, where it prevailed several times during the -present century, and where it is known as the _Maha-Mari_. It is also -said that it prevailed in 1815 on the Island of Kutch, and lasted till -1821 in Kutch and Sindh. It also occurred between the years 1828 and -1838 in Jhansi, Bareilly, Pali and Jodhpore. In China the plague has -been present for a long time in an epidemic form. In 1894 60,000 persons -died at Canton. From Canton it spread to Hongkong and to Amoy. In 1895, -it visited many places in Southern China. In 1896, it was present at -Hongkong. Some people think that the disease has come to Bombay probably -from Singapore. There was an epidemic at Merv when the Bombay outbreak -appeared, others, however, think that the epidemic at Merv was not that -of plague and that the disease has come from Hongkong. - - - - - _THE LONDON EPIDEMIC OF 1665._ - - -The following graphic and interesting account of the great London -Epidemic of 1665 is taken from Sir William Guy’s book on “Public -Health.” - -“I now turn for a more exact account of the plague of 1665 to the work -of Dr. Nathaniel Hodges, a Fellow of the College of Physicians, resident -in the City, and, as his book shows, in active practice among the -victims of the disease. - -“Dr. Munk, in his roll of the Royal College of Physicians of London, -says that he ‘acquired a great name among the citizens of London; that -he remained at his post and continued in unremitting attendance on the -sick,’ and that ‘during the latter part of his life he received a -regular stipend from the City of London for the performance of his -charitable office.’ - -“Dr. Hodges tells us that about the close of 1664, two or three persons -died suddenly with symptoms of the plague in one family at Westminster, -that some timid neighbours of theirs took fright and removed into the -City of London carrying the taint of pestilence with them whereby the -disease, which existed only in a family or two, gained strength and -spread abroad, and ‘for want of confining the persons first seized with -it, the whole city was in a little time irrecoverably infected.’ - -“In December a hard frost set in, which lasted three months, and during -that time very few died of the plague. But the disease was not -extinguished; for, in the middle of the Christmas holidays, the doctor -was called to a young man in a fever, who after two days ‘had two -risings about the bigness of a nutmeg,’ ‘one on each thigh,’ with a -‘black hue’ and a ‘circle round them.’ By these and subsequent symptoms, -he judged it to be a case of plague. It did not prove fatal. - -“When the frost broke, the disease gained ground and extended into -several parishes; and the authorities issued an order ‘to shut up all -the infected houses,’ so as to prevent ingress and egress. To give -effect to this order, the houses of the infected were to be marked with -a red cross, and to carry the inscription, ‘_Lord have mercy upon us_,’ -and a guard was set whose duty it was to hand food and medicine to the -sick, and to prevent them from going abroad till forty days after their -recovery. In spite of these harsh measures, ‘the plague more and more -increased.’ Nor will this surprise us if we imagine the frantic and -successful efforts that must have been made by the non-infected to -escape, and the temptation to servants and nurses to appropriate and -remove the property of the dying and dead. Indeed, Dr. Hodges accuses -the nurses of strangling their patients, and secretly conveying the -pestilential taint from sores of the infected to those who were well; -and he justifies his accusation of ‘these abandoned miscreants,’ the -Gamps and Prigs of the seventeenth century, by two instances; the one of -a nurse who, ‘as she was leaving the house of a family, all dead, loaded -with her robberies, fell down dead under her burden in the streets,’ the -other of a ‘worthy citizen’ ‘who, being suspected dying by his nurse, -was beforehand stripped by her; but recovering again, he came a second -time into the world naked.’ - -“In spite of the well intentioned measures of the authorities, the -plague continued through May and June with more or less severity, -sometimes in one place, sometimes in another, till the people becoming -thoroughly frightened, flocked out of town in crowds. But the disease -raged with redoubled fury among those that remained. Then the -authorities bestirred themselves to the utmost. They instituted a -monthly fast; and the King commanded the College of Physicians ‘to write -somewhat in English,’ that might serve as ‘a general directory.’ The -college not only obeyed the royal commands, by inventing a ‘_Plague -Water_,’ consisting of a cordial distilled off from a vinous infusion of -a score of very harmless roots, leaves, and flowers, but also appointed -two of their number to co-operate with two chosen from among the -aldermen in attending the infected; while Dr. Glisson, Regius Professor -at Cambridge, and Drs. Paget, Wharton, Berwick and Brookes volunteered -their help, with many others who survived, and eight or nine who fell -victims to their self-devotion, among whom Dr. Conyers receives -honourable mention. - -“Still, in the face of every precaution, the plague continued its work -of destruction, especially among the common people, so as to be called -the ‘_Poor’s Plague_,’ and, in August and September, completely got the -mastery, ‘so that three, four or five thousand died in a week, and once -8,000.’ - -“And here I will follow Dr. Hodges’ example, and try to give you some -idea of the state of things then prevailing. But in doing so I must -shorten and tone down his description. ‘In some houses,’ he says -‘carcases lay waiting for burial,’ ‘in others, persons in their last -agonies.’ ‘In one room might be heard dying groans, in another the -ravings of delirium,’ and, near at hand, relations and friends bewailing -their loss and their own dismal prospects. ‘Death was the sure midwife -to all children, and infants passed immediately from the womb to the -grave.’ Some of the infected ran about staggering like drunken men, and -fell down dead in the streets, or they lay there comatose and half dead; -some lay vomiting as if they had drunk poison; others fell dead in the -market in the act of buying provisions. The plague spared ‘no order, age -or sex.’ The divine was taken in the very exercise of his priestly -office, and the physician while administering his own antidote; and -though the soldiers retreated, and encamped out of the city, the -contagion followed, and vanquished them. Many in their old age, others -in their prime, most women and still more children, perished; ‘and it -was not uncommon to see an inheritance pass successively to three or -four heirs in as many days.’ There were not sextons enough to bury the -dead, the bells ceased tolling, the burying places were full, so that -the dead were thrown into large pits, dug in waste ground, in heaps 30 -or 40 together; and those who attended the funerals of their friends one -evening were often carried the next to their own long home. - -“This is written of a time when the worst had not yet happened. It was -about the beginning of September that the disease was at its height. -Then fires were ordered to be burnt in the streets for three days -together; but before the time had expired, they were extinguished by -heavy rains, which ushered in the most fatal night of all with its -register of more than 4,000 deaths. - -“From this, its culminating point, the plague, ‘by leisurely degrees -declined,’ ‘and before the number infected decreased, its malignity -began to relax, insomuch that few died, and those chiefly such as were -ill-managed.’ Dr. Hodges distinctly states that the pestilence did not -stop for want of subjects, but from the nature of the distemper. ‘Its -decrease was, like its beginning, moderate.’ Early in November, people -grew more healthful, and though the funerals were still frequent, ‘yet -many who had made most haste in retiring, made the most to return;’ -‘insomuch that in December, they crowded back as thick as they fled.’ -The houses were again inhabited; the shops re-opened; the people went -cheerfully to their work; the rooms, in which a short time before -infected persons had breathed their last, were peopled afresh, and many -went into their beds ‘before they were even cold or cleansed from the -stench of the diseased.’ ‘They had the courage now to marry again,’ ‘and -even women, before deemed barren, were said to prove prolific, so that, -although the contagion had carried off, as some computed, about 100,000, -after a few months, their loss was hardly discernable.’ But the next -spring there appeared ‘some remains of the contagion,’ which was easily -conquered by the physicians; and the whole malignity ceasing, the city -returned to perfect health, as after the great fire, ‘a new city -suddenly arose out of the ashes of the old, much better able to stand -the like flames another time.’” - - - - - _GEOGRAPHICAL DISTRIBUTION._ - - -Plague is known in Europe, Asia and Africa, but it has not been known in -the Western Hemisphere. It is said that Mesopotamia is the home of -plague. It has been known as far North as Astrakhan in Asia and Norway -in Europe. During the last fifty years, however, it is chiefly confined -to Asia from Red Sea on one side, and the shores of the Pacific on the -other. Some are inclined to think that the plague was carried from -Himalyan India across Thibet to Yanon in Chinese territory, thence to -Pekoi whence it made its way to Canton and Hongkong. If that be so, then -the plague has accomplished a tour from Northern India _viâ_ China by -Sea route to Southern India within a period of twenty years between 1876 -and 1896. - - - - - _CAUSES_— - - -A disease so fatal in its nature and against which human power is so -futile was in ancient times naturally attributed to wrath of the gods. -Supernatural, astrological, and, in some instances, rationalistic causes -were assigned to it. In the fourteenth century the College of Physicians -of Paris ascribed it to the influence of constellations in India. But -more natural explanations, however, gradually followed. Putrefaction of -dead animals was assigned as a cause in Egypt. Poisoning of water-supply -was also believed to be the cause. Undue heat, rain, watery grain, and -absence of the Etesian winds were thought to generate plague. Leaving -ancient theories on the causation of the disease we find that modern -Scientists divide themselves into two classes: _first_, those who -believe in the germ theory and attribute the plague to a specific germ, -holding that germs can never arise _de novo_; _second_, those who -believe that atmospheric changes and certain telluric conditions or -insanitary surroundings engender the seeds of pestilence which are -carried through air, water or other media. The arguments in favour of -the first theory are, however, so strong and overwhelming, that it is -now almost universally accepted that plague is due to a specific poison -which grows and multiplies under favourable conditions, and that -wherever it occurs it is caused by the implantation of those germs in a -suitable soil. If the soil is not fit, the germs may be sown, but they -will not germinate and, if the soil is fit but the germs are absent, the -disease will not be seen. The soil best suited for the plague seed is -one where insanitary conditions prevail. Dirt and filth, bad -ventilation, and overcrowding are its manure. The history of plague from -ancient times fully illustrates that plague thrives in dirt, filth, -squalor and misery. Diseased grain and want of subsoil drainage are held -to be potent factors in the diffusion of plague. - - - - - _BACILLUS_— - - -During the Hongkong epidemic the great Japanese bacteriologist Kitasato, -who formerly worked with Koch in Germany, discovered a bacillus in -plague-stricken patients, and showed by experiments that these bacilli -if injected into lower animals produced in them symptoms of plague. -Yersin simultaneously discovered the same germs in connection with -plague. According to our modern notion of the causation of the disease, -these germs must be considered to be the specific poison which produces -the symptoms of plague. The bacilli are found in the blood, in the -buboes, and in all internal organs of the victim of the plague. They are -short rods with rounded ends, with a clear space or band in the centre, -readily stained by the aniline dyes and showing very little power of -movement. The size of the plague bacillus varies, and bacilli of same -character, but of less virulent nature, have been found in the soil of -infected places. Some bacteriologists observed some development after -death in the bacilli, this, if confirmed by observations at Bombay, will -be highly interesting from a bacteriological point of view. If mice, -rats, guinea-pigs and rabbits are inoculated with the plague bacillus, -they soon become infected and die, and in their internal organs the same -bacilli are found. They are also found in the soil and dust of houses -where plague patients were kept, but not invariably so. Kitasato found -the bacilli in the blood of patients convalescing from an attack of -plague even three or four weeks after all symptoms have disappeared. It -has been found that the bacillus dies after four days, during which it -is kept at a dry heat, or at the temperature of 80°C. or 176°F. for half -an hour, or at that of 100° C or 212°F. for a few minutes. Its resisting -power to chemical disinfectants is feeble, dying in a 1 per cent. -solution of carbolic acid or of lime water. It develops easily in many -culture media at the ordinary temperature (from 18° to 22°C). An -alkaline solution of Peptone 2 per cent., with from 1 to 2 per cent. of -gelatine, is the best nutrient medium for its cultivation. - - - - - _CONTAGIOUS AS WELL AS INFECTIOUS._ - - -Experience has proved that plague can be transmitted from one person to -another by direct contact; when a case of plague occurs in a house, -other inmates of the house are much liable to be attacked also. Visitors -to the house, medical and other attendants are also liable to be seized -or to carry with them fresh focus of infection. It was, however, found -in the Hongkong epidemic of 1894 that none of the European medical men, -some fifteen in number, nor any of the Chinese students who were on duty -at the plague hospital died. During the Egyptian epidemic of 1835 a -French doctor, Bulard, with the courage of his conviction that plague -was not contagious wore the shirt of a patient who died from plague, and -yet did not contract the disease. Such immunity, however, was probably -due to some circumstances which might be easily explained. In the -Hongkong epidemic of 1894 three Japanese medical men contracted the -disease, and in 1896, some European nurses were attacked. In Bombay the -sad deaths of Surgeon-Major Manser and Miss Joyce prove that contagion -plays an important part in the spread of the disease. - -It has been maintained that plague is a miasmatic or soil-bred disease, -and that the germs find in earth, water or in some form of fermenting or -decomposing material a suitable nidus for growth. In this sense it is -like malaria, which is endemic in a particular suitable area appearing -and disappearing according as climatic or other conditions are -favourable or unfavourable. The Chinese have a peculiar idea of the -infection of plague. They consider that the plague rises from the soil -and believe that it first attacks small animals with breathing organs -near the soil, such as rats, then animals with breathing organs a little -higher, such as poultry, pigs, dogs, goats, cows, so on till it reaches -man, whose breathing organs are higher from the soil than those of other -animals. - -The rats are undoubtedly attacked with plague before and during its -prevalence among human beings, and they play an important part in the -spread of its infection. In Kumaon this rat plague was observed by the -people, and was recognized as a forerunner of the plague. The _Times of -India_, September 30th, 1896, contains the following:—“It was known more -than a month ago to all the people of Mandavi and to all the municipal -sweepers in the district that the rats were dying in thousands all over -the districts. They were found dead and dying almost everywhere, and in -places where dead rats were never found before.” In Bombay an instance -has been reported of a man trampling with bare foot on a rat which was -seen slowly passing in a room and getting attacked by the plague soon -after. Pigs, dogs, snakes, and jackals are said to be also affected by -the plague. It will be seen that flesh-eating animals are the sufferers, -due evidently to their eating plague flesh. Snakes swallow rats, and -rats become infected by consumption of poisoned material or from -infected soil or by their cannibal habit. Like other diseases due to a -specific germ, the infection of plague may be caught from various -sources such as the following—(_a_) By means of breath. Plague dust and -dirt are very potent infective agents. A man getting a whiff of dust -from the floor of a room in which there is a plague patient blown into -his face may get the infection. Sweepers and others engaged in -conservancy are, therefore, easily attacked. (_b_) By food or drink. -Grain adultered with sand or earth infected by rats may be a source of -infection. Food may also be infected by flies or diseased rats (_c_) By -direct inoculation through any abrasion in the skin or mucous membrane. -People with bare feet are, therefore, more liable to catch the -infection. The infection may be spread by infected linen, bedding, -furniture and fomites. The discharge from buboes contains the germs, and -is, therefore, highly poisonous. The fæces, the urine, the sputum, the -fur on the tongue are also infective. If the theory be true that the -poison attaches itself to the soil, then persons living on ground-floor -are more liable to the infection, and a floating population less so. -Dust laden with germs is the principal agent in the diffusion of plague -as that of any other germ disease. Professor Aoyama of Tokyo, whilst -making a _post-mortem_ examination, scratched the left third finger and -was attacked with the plague, also Dr. Ishigami, assistant to Kitasato. - - - - - _NATURE OF AN EPIDEMIC._ - - -Plague is a very slow disease; it takes some weeks to travel from one -quarter of a city to another. It took nine months to travel from the -city of London to Soho, and ten from Hongkong to Macao—a distance of 30 -miles. Thousands of persons from Canton and Hongkong sought shelter at -Macao, and there was free communication between these places, still -Macao became affected nine months after plague ceased at Hongkong. When -plague is first imported in a place, for three or four weeks isolated -cases occur in one neighbourhood. An epidemic may last only a few weeks -or months, but may extend over several years in sporadic form and a -recrudescence takes place abruptly. In Mesopotamia plague declines and -becomes dormant with the setting in of the hot weather, its activity -reawakening in winter and gathering force with the advancing spring. The -same was the case in Egypt. In Constantinople, on the contrary, as well -as in England, the disease was dormant during the cold months but became -active during the hotter. In England, September was the month of -greatest prevalence. In the epidemic at Bengazi in 1858 as well as in -Mukai in 1863 famine and plague were found together. That a water-logged -soil favours famine was illustrated during the epidemic on the Lower -Euphrates in 1867. In Persia and Arabia many epidemics were self-limited -and spontaneously came to an end after spreading on a certain area, -while, on the other hand, it has been known to obtain an endemic -foot-hold, the virus remaining from year to year, and, occasionally -under the influence of meteorological or unknown causes, becoming -epidemic among the population. - -_Race._—No race seems to enjoy an immunity from the plague. - -_Geology and Climate._—Except the new hemisphere the plague has found -congenial soil everywhere. It thrives as much in high and dry altitudes -as in low-lying places, as much in overcrowded towns as in sparsely -populated semi-desert regions. In temperate regions it has been known to -rage in summer, but in Astrakhan it prevailed when there were several -feet of snow on the ground. On the Volga it prevailed during the -severest cold (1878-79), as well as in the extreme heat of Smyrna -(1735). In Bombay it commenced at the end of an exceptionally dry -season, as it did in South China. During the Hongkong epidemic the rains -increased it. The increase of the epidemic at Hongkong with the rains -was probably due to the fact that the rains drove people into infected -houses, instead of sleeping outside, as they did in summer when the -weather was good. It has been said that plague flourishes in a warm -moist atmosphere and dry hot air kills it, but there are records of -plague thriving in conditions antagonistic to this theory. A temperature -between 60° and 85°F. is said to be very favourable to it. - -_Sex and Age._—Both sexes are equally liable. It is said that people -between the ages of 10 to 30 are frequently attacked. But experience -shows that children and old people are alike liable to attack. In Bombay -the disease has occurred most frequently between the ages of 20 and 30, -and the male sex has suffered more than the female. - -_Occupation._—During one epidemic, water-carriers, or those who used -much water, or who dealt in oil and fats were found comparatively free; -but this observation cannot be relied upon. Those whose business -requires them to come much in contact with the sick, and also those who -are engaged in cleaning are naturally more exposed to infection. It has -been said that one attack generally protects from a second, which, if it -occurs, usually runs a mild course. - -_Sanitation and Personal Hygiene._—Plague, germs thrive in filth. Bad -hygienic conditions, over-crowding, insufficient ventilation, and -absence of sunlight in dwelling houses, accumulation of decomposing -organic matter, effluvia from bad drains, sewer and cesspools are causes -that favour the growth and dissemination of an epidemic of plague. When -it attacks a town, it, therefore, naturally selects first the poorer -classes who live in ill-ventilated and over-crowded houses. -Over-crowding within dwelling houses is a fertile source of producing a -constitution fitted for the reception of plague-germs. Such portions of -towns where there is much congestion and over-crowding suffer most. -Scarcity of food favours plague. It has been called _Miseriæ Morbus_, or -the disease of misery, and the plague of London was called the “poor’s -plague.” In Kumaon there is the usual custom of keeping cattle in the -lower room of a hut, where a crowd of cattle stand udder deep in fœtid -straw. In one of the rooms of the upper storey grain is kept, and in -another the whole family sleeps with doors and windows shut. Such -conditions are undoubtedly very favourable to plague. - -_Predisposition._—Chill and exposure to cold, indigestion and any other -disease producing a debilitated condition of body, fatigue, overwork, -error of diet, mental emotion, and a terror of attack are predisposing -causes. Catarrhs often predispose an attack. - - - - - _INCUBATION._ - - -Or how long does it take for the poison to develop symptoms after -infection: generally three to six days, but the period may be up to ten -days. The period varies with the virulence of the poison. The germs, -however, remain active outside a host for a long time. An instance has -been reported, in which a man, after handling some ropes which 20 years -previously had been used in the burial of plague corpses, took the -disease and died of it. - - - - - _SYMPTOMS._ - - -The usual premonitory symptoms are headache, loss of appetite, a feeling -of general depression and aching of limbs. These symptoms may either be -mild or may appear at once in very aggravated form; violent headache -being usually of an acute dull character, accompanied by throbbing in -the temples, giddiness, sleeplessness, palpitation, a feeling of -oppression of the chest, even mental delusion may appear on the first -day. The look of the patient is anxious, pale and cyanosed. The -expression of the face resembles that of a man who has had no sleep for -two or three nights but is being overpowered with the fatigue consequent -to it. These symptoms are usually ushered in with a rise in the -temperature. Well-marked rigor is usually not seen, but a slight shiver -or chillness is complained of. Pulse is full, bounding and rapid—130 or -more per minute. Respiration is difficult and accelerated even to 40 or -50 per minute. Skin is dry and hot, face puffed, conjunctivæ congested. -Sense of hearing is dull. Speech is thick and faltering. Tongue is dry -and coated with greyish white or dark brown heavy fur. Violent thirst is -present. Sometimes Patchiæ appear on the skin. In a few hours, or a few -days after the appearance of the first symptoms, a swollen gland appears -either in the neck or axilla or groin. The gland most commonly affected -is one or some of the femoral chain. An inguinal, axillary or a cervical -gland may also be affected. A number of glands may swell at one time or -glands in all the above situations may be felt painful and swollen. The -glands of the neck are most frequently attacked in children. Pains in -the lower part of the abdomen and along the spine indicate affection of -internal lymphatic glands. In some cases the first symptom noticed is a -swollen and painful gland, but fever soon manifests itself. The -glandular enlargement may antedate, coincide with, or follow the rise in -temperature. Sometimes only pain in the gland is complained of, but no -swelling is observed. The temperature rises gradually and goes up to -104°, 105° or 106° F. In some cases a temperature of 108° was observed. -There may be a marked morning fall and an evening exacerbation, which is -a favourable sign, or the temperature may remain high persistently. All -the above symptoms become soon aggravated when the second stage or stage -of acute development of the disease appears. Brain symptoms show -themselves. Lowson noticed four distinct type of brain symptoms—(1) -comatose, when the patient lies paralysed, mind and body; (2) wildly -delirious, when the patient struggles and fights and still retains a -fair command of rational speech; (3) apathetic, when he lies perfectly -quiet but is drowsy; (4) convulsive, which condition occurs when there -is inflammation of the meninges or hæmorrhage in the brain. - -In this stage all symptoms of a pronounced typhoid condition supervene. -Tongue becomes parched and black. Sordes cover the teeth. Gradually a -somnolent condition and low muttering delirium supervene. In some cases -the delirium is violent and furious, while in others it culminates in -complete stupor and coma. Picking of the bed-clothes, and subsultus -tendinum are common, and the urine and fæces are passed involuntarily. -The pupils are dilated. The skin is bathed with profuse perspiration. -The pulse is dichrotic and compressible, and gradually becomes -anachrotic and intermittent till it finally fails. The area of cardiac -dullness is increased and pain in the cardiac region is complained of. -Heart begins to fail rapidly. The usual complications of this stage -are—(1) meningites; (2) hæmorrhages; (3) severe gastric disturbance, -such as vomiting, diarrhœa, hiccough. As a rule, constipation is found -during the course of an attack, but diarrhœa, even severe, may appear. -There may be pain in the abdomen. Bladder may be distended and a -catheter may be necessary to evacuate it. Cystitics often develop. Œdema -of the lungs, pleurisy and pneumonia may also complicate a case. -Hæmaturia, hæmoptysis and hæmatemesis may be seen. Bronchitis and -hypostatic inflammation may occur. The urine always shows presence of -albumen. Death may take place from cardiac failure or from any of the -above complications. Death may take place within three or four days, -though in some virulent cases the patient dies within twenty-four hours. -If the primary collapse is tided over, there is great chance of -recovery, still deaths often occur of complications several days after -the attack. - -In mild cases the second stage is not so severe, and temperature may -fall by lysis or crisis—the latter being rare. - -The glands in the meantime become swollen and are surrounded by a -sero-sanguinous exudation. The surrounding parts are œdematous. The -glands usually do not suppurate, but they may do so and slough. The -usual course after their enlargement is one of four: (1) resolution; (2) -lengthened period of enlargement; (3) suppuration; (4) sloughing. In -cases that recover the symptoms gradually take a favourable turn and -recovery is as rapid as the attack. The fever slackens, the pulse -becomes stronger, the tongue moist and the typhoid symptoms gradually -pass away. The buboes either suppurate or subside; symptoms of secondary -pyaemic conditions, however, may sometimes develop. Deviations from the -typical course are, however, often observed. Some cases take an -extremely rapid course, the patient succumbing within from 12 hours to -two days. The duration of the disease varies between a few hours and a -few weeks, but on an average up to the commencement of the convalescence -it seems to last from 6 to 10 days. During convalescence the vitality of -the issues are very low. Head symptoms sometimes persist for some time. -Temper is irritable. The sloughing glands often take a long time to -heal. Convalescence is soon established. - - - - - _VARIETIES._ - - -Just as before an epidemic of cholera visits a place, it is usual to -observe cases of mild diarrhœa, and indigestion prevailing amongst its -population; so, before plague actually breaks out, it has been found -that cases of buboes and parotites with fever are commonly observed. -Such cases were called _Pestis Minor_ at Astrakhan. “No one died from -the disease _per se_, but few people were confined to bed.” It is not -known whether in _pestis minor_ the plague germs could be found; but -presumably not. - -Drs. Simpson and Cobb of Calcutta have described what is called _Pestis -Ambulans_, or an ambulatory form of plague, in which plague germs have -been found. The commonly accepted types of plague are (1) Fulminant; (2) -Typical; (3) _Pestis Minor_ (including _ambulans_). The cause of the -first two is the bacillus discovered by Kitasato, and they are very -fatal, of the third, the cause may be an allied bacterium less potent to -produce toxic effects on man, and it may come and go but plague may not -break out. In ambulatory form the patient has slight fever and glandular -enlargement, but he can move about. - - - - - _DIAGNOSIS_— - - -It is difficult to differentiate a case of true plague in its early -stages from a case of fever with benign glandular swellings or mumps. -The premonitory symptoms of plague, and even the early symptoms of the -first stage, may be due to many different diseases and therefore great -caution is needed. It is needless to say how important it is that such -diagnosis should be done with great care, specially when plague cases -have to be isolated, for if a case of simple fever with benign -lymphadenitis be brought in close contact with patients suffering from -true plague, it is a serious matter with the former. A venereal bubo, or -scrofulous enlargement of glands, or enlargement of femoral or inguinal -gland due to traumatic or other causes which may be attended with fever -should not be mistaken for a plague symptom. A medical man who has, -however, carefully observed the facies of a few cases of true plague, -and who carefully takes into consideration all other probable conditions -which may be mistaken for plague, may not commit a mistake, but its -probabilities are to be borne in mind. The practical lesson is, that all -doubtful cases should be isolated and kept separate from cases of -pronounced type. The plague bears some resemblance to typhus. Murchison -says: “Plague is perhaps the typhus of warm climates, the two diseases -being generated from similar causes and differing only in intensity from -the effects of climate and other collateral circumstances.” In typhus -there is a characteristic rush, and in plague there is bubo, but this -order of things have been found in some instances to have changed, there -being eruption in plague and bubo in typhus. The two diseases are, -however, different and bacteriological and clinical evidence corroborate -this view. Cantlie adds another disease, which he says he mistook for -plague:—“On June 26th, 1894, when the plague was at its height, I saw a -Parsee patient dwelling in a house in which plague existed, suffering -from fever 104°(F.), dry tongue, headache, backache and large swollen -glands in the left groin, which had suddenly appeared. Plague seemed the -only diagnosis, and the man, much against his will, was sent to the -plague hospital. In two days he came back again quite well, and on -examining him I found his urine thick and milky. That night I found -filaria in the man’s blood, and knew I had made a mistake in the first -instance. Of course, the mistake is most likely to happen, but -nevertheless it is not pleasant to think that we had subjected the man -to the terrible danger of plague infection.” - - - - - _PROGNOSIS._ - - -The mortality from plague may be about 90 per cent. or more when the -epidemic is at its height. In the beginning, or towards the end of the -epidemic, the mortality is less, as it is the case with all other -epidemic diseases. The average mortality at Bombay has been 84 per cent. -and in Karachi 89 per cent. It is, therefore, more fatal than all other -epidemic diseases, the mortality from cholera during the height of an -epidemic being about 60 per cent. - -In children and in the aged the disease is more fatal than in healthy -adults. Cases in which the bubo appears early and is single, or in which -there is a distinct morning remission, or less general prostration or -free perspiration, or in which there is no diarrhœa, have greater chance -of recovery. Rapid suppuration of the buboes indicates a favourable -termination. Buboes do not suppurate as a rule until the primary fever -has fallen. On the other hand, carbuncles, multiple buboes (specially on -the neck), meningitis, hæmorrhages, pleurisy, pneumonia, diarrhœa, -gastric irritation, cyanosis, jaundice and continued pyrexia are -unfavourable signs. - - - - - _MICROSCOPIC AND MACROSCOPIC APPEARANCES._ - - -Bacilli are found in all the internal organs, notably in the spleen, in -blood and in the enlarged glands. - -Body does not show much emaciation; decomposition commences early. Black -hæmorrhagic patches are often found on the skin. The brain and membranes -are congested. Sanguinous or serous effusions are found in serous -cavities. Right side of the heart is dilated and is usually found full -of coagulated or liquid blood. Cardiac muscles pale. The liver is -enlarged and congested. The spleen is much enlarged, soft and congested. -Hæmorrhagic patches have been found in the stomach. The mesenteric -glands are enlarged. Kidneys congested. Bladder is sometimes found -filled with bloody urine. The buboes are sometimes found to be soft and -caseous. The tissues surrounding them are infiltrated with a reddish -gelatinous exudation. The whole lymphatic chain from groin to the glands -of the sacral or lumbar plexus, or from the axilla and neck to the -glands of the mediastinum are affected. The internal glands are found -more or less enlarged, injected and infiltrated with sanguineous fluid. -The lymphatic follicles and Peyer’s patches in the intestines are found -swollen. Hæmorrhages are found in the mesentery. - - - - - _PREVENTION._— - - -It is evident from what has been said that to prevent plague our efforts -should be directed in two ways:—(1) To prevent the importation of germs; -(2) to make the environment of a place such that the germs, even if -imported, may not find suitable condition for their growth. To -accomplish the first we need (_a_) inspection of people coming from -infected places; (_b_) stopping importation of such articles as may -carry infection with them; (_c_) quarantine, a word which owes its -origin to the fact that, daring the epidemic of plague at Milan in 1527, -patients when cured were despatched to lazarettos and detained there 40 -days. - -For the second, we require (_a_) sanitary precautions by guardians of -public health; (_b_) observance of rules of personal hygiene by which -good health can be maintained. - -(1). Wherever possible a medical inspection should be made to prevent -importation of the disease. This is, however, a very difficult matter, -and one unforeseen difficulty was experienced at Sukkur, where it was -found that people booked to stations short of Sukkur, and rebooked at -stations on the other side. Still this measure is highly important, and -should be carried out most rigorously as long as there is any chance of -importation of plague into an unaffected country. It is needless to feel -the pulse of the patient; his gait, temperature, and look would afford a -great deal of information. Information should be obtained from where the -patient is travelling. An examination should also be made of clothes. -Dirty clothes, soiled linen and rags should not be allowed to pass -through an inspection post. - -(2). There should be a disinfecting or sterilizing room fitted with a -steam sterilizer in all large railway stations, where all goods should -be disinfected. Mail bags should also be subjected to this disinfection. -Transmission of such goods as corpses, used clothes, rags, waste paper, -fur, hide, feather, and fish should be entirely suspended. - -(3). If quarantine is imposed, it should be for a period not less than -ten days. Every arrangement, however, should be made for suitable -accommodation and sanitation in quarantine camps. In a quarantine camp -new arrivals should not be mixed up with those who are already in -quarantine. - -(4). Ships from infected ports should be carefully watched. If any -infection is discovered, then isolation of the sick, disinfection of the -ship and quarantine are required, but ships with clean bills of health, -and if ten days have passed since its departure from the infected port, -may be admitted after medical inspection. It must, however, be borne in -mind that rats could easily carry infection from one port to another -without any fear of detection. These facts show that medical inspection -and quarantine may be useful, but they can never be perfect, and -therefore the principal safeguard of a place lies in the improvement of -its sanitation, and therefore greater attention and energy should be -directed towards it. - - - _Sanitary Measures that should be taken by Municipal and Railway - authorities._ - -(1). All filth should be removed from the vicinity of towns and villages -and _burnt_, and no filth of any kind should be allowed to remain within -an inhabited area for any length of time. - -(2). All private and public latrines and public urinals should be -cleaned and disinfected daily. All receptacles used for night-soil -either in the latrine or for transport should be daily disinfected. - -(3). Latrine accommodation, according to the requirements of the -population, should be provided. - -(4). Drains should be well washed and flushed with a disinfectant -solution. In towns where there is an underground sewer, it should be -well flushed and ventilated, and a disinfectant solution used for -cleaning it. A house-to-house examination should be made to ascertain -that all house-connections are properly and efficiently trapped. -Deposits in the sewer should be taken out and suitably disposed off -after disinfection. - -(5). Special attention for cleansing should be given to the following:— - -Cesspools, privies, cow-houses, stables, slaughterhouses, markets, -workshops, common lodging houses, serais, bustees, and crowded quarters -of a town. - -(6). All public roads should in the dry season be watered with a weak -disinfectant solution. - -(7). Pure drinking water should be supplied. All articles of food should -be inspected. Musty and decomposing grains should not be allowed to be -sold. The meat market, dairies and bakeries should be under strict -sanitary supervision. - -(8). Over-crowding in houses should be prevented. Steps should be taken -for spreading out the population of much over-crowded and congested -parts of towns. - -(9). Lime in a dry state and in solution should be abundantly used in -drains, &c. - -(10). All railway carriages travelling through infected areas should be -daily washed with a reliable disinfectant solution, such as 5 per cent. -carbolic acid. - -(11). Railway platforms, waiting rooms and halls, and latrines should be -frequently cleaned and disinfected. - -(12). There should be a system of house-to-house inspection to ascertain -the sanitary condition of dwelling-houses, and also to find out, as far -as possible, the condition of health of the inmates. - -Common lodging houses, serais and houses of a similar nature should be -most carefully examined. - -(13). If plague breaks out, then isolation of cases is a great -necessity. When practicable, such isolation may be done in the house of -the patient. The patient should be kept in a separate room apart from -those where other inmates of the house live. A temporary room could be -put up on the roof of a house or in the compound, if there is any, or a -tent may be pitched. Where possible, all healthy inmates of the house -should at once remove themselves in camp leaving only such near -relatives who must attend and nurse the patient. For patients living in -lodging houses, or, where there is no means of such isolation as stated -above, segregation in special isolation hospitals should at once be -done. The isolation hospitals should be separate for each of the -following classes—(_a_) for lower class people; (_b_) for middle class -people; (_c_) for such people of the middle or upper class who may chose -to pay for their expenses. It is needless to say that there should be -special hospitals for women, where only female attendants and nurses -should be employed. Hospitals should be provided with means for free -ventilation, both for the sake of patients as well as attendants. No -other disease requires more careful nursing than the plague, therefore -ample nursing staff should be provided. The hospitals should have a -separate observation ward and a separate convalescent ward, and by no -means doubtful cases should be mixed up with confirmed cases. -Disinfecting apparatus, sterilizers, good water supply and special -laundry are other adjuncts essentially necessary for a plague hospital. -Greatest care is required in the management of such a hospital, and only -trained men should be employed. - -Suitable means for ambulance should be provided, and should be had ready -within convenient distances. They should be thoroughly disinfected after -the conveyance of any case. Ambulance carts or doolies should be -comfortable, for physical exertion and exhaustion, attending a long -journey in the early stage, greatly compromise chance of recovery. - -Burial within inhabited areas of a town or village should be stopped. -Dead bodies should be removed under strict precautions for disinfection -and disposed off quickly. Bodies should be buried deeply—4 to 6 feet. - - - - - _PRIVATE HYGIENE._ - - -I. Houses and compounds, stables, kitchen and outhouses should be -thoroughly cleaned, and they should be whitewashed with lime. Air-tight -dustbins should be kept in the house. - -II. Rooms, specially bed-rooms, should be well ventilated, attention -should be paid to the condition of the floor, which should not be damp, -and care should be taken that rats may not infest the house and spaces -under the floor. If dead rats are found in the house, they should be -removed and burnt, and the place thoroughly disinfected. - -III. House drains should be cleaned and well flushed with a disinfectant -solution. - -IV. Nowhere in the house or compound should any kind of organic refuse -be allowed to accumulate. Better not use any organic manure in the -kitchen garden or house garden during an epidemic. - -V. Articles of food should not be allowed to remain uncovered on the -table or elsewhere, for there is chance of their infection by flies, -mice, or rats. - -VI. Clothes received from the dhoby’s house should be again boiled in -water, dried, and then used. - -VII. Bed-clothes and wearing apparel should be aired and exposed to the -sun daily. As frequently as possible floors and passages should be well -washed with a disinfectant solution and then well dried. - -VIII. There should not be any over-crowding in bed-rooms. - -IX. Drinking water should be boiled before use. Raw vegetables, such as -salad, cucumber, &c., should only be used after thoroughly washing them, -and then with vinegar. - -X. Personal cleanliness should be strictly observed. Daily bath, -cleaning the teeth with carbolic tooth powder, and carefully washing -hands and mouth before and after meals are essential. - -XI. Those who have to attend on plague cases should be very careful. -Hands should be thoroughly washed with a disinfectant solution, and a -nail brush used soon after the patient or anything in contact with him -is touched. A bath to which some antiseptic is added should be taken -immediately after coming in contact with plague patients. Workers in -plague hospitals should be warned about scratches or wounds on their -bodies. Use of respirators with an antiseptic sprinkled over the -entrance valves is recommended. Only very healthy people should approach -plague cases. On the appearance of slightest headache, languor, or fever -an attendant should be relieved from duty. - -XII. As a prophylactic 5 grains of quinine sulphate may be taken twice -daily, or a small bottle containing eucalyptus or some other volatile -disinfectant, may be carried in the pocket, and a few drops may be -occasionally poured on the handkerchief. Smoking good tobacco may have a -prophylactic value. - -XIII. If plague occurs in the house, the following steps should be -taken:— - -(_a_) The patient should at once be put in bed and kept in a temporary -room, which may be put up on the roof of a house. No healthy inmate of -the house should go in that room or have any connection with the sick, -except those who have to nurse the patient. - -(_b_) All discharges, fæces, urine, sputum, vomited matter, &c., should -be taken in vessels with disinfectant solution in it, and some quicklime -should immediately be sprinkled over them. On no account should anything -leave the room but to be disinfected. - -(_c_) Floor and bedsteads should be washed with a disinfectant solution, -clothes and other articles that touch the patient should be carefully -disinfected. Crockery and glass should be scalded. If great care and -cleanliness are not observed with regard to the bed and body linen of -the patient, the infection may be diffused through the air immediately -around the patient. - -(_d_) A medical man should be at once sent for. Delay is fatal. - - - - - _INOCULATION AGAINST PLAGUE._ - - -M. Haffkine, of cholera inoculation fame, has commenced to inoculate -against the plague under the same principles on which his inoculation -against cholera is based. By injecting into the body an attenuated virus -of plague, a very mild attack is produced, which in people inoculated -has proved harmless. This mild attack, it is thought, would protect the -system from more potent forms of the poisonous germs. The inoculation -for plague is still in its experimental stage, and cannot, for obvious -reasons, be applied to a large population. Medical attendants, nurses -and others who, by call of duty, have to constantly come in contact with -plague patients may, however, take advantage of this means of -protection, which, in the hands of M. Haffkine, may yield good results. -Yersin also claims for his serum prophylactic value. In this and all -other matters connected with bacteriology, such as germs, -sero-therapeutics, &c., the medical profession now-a-days receives a -good deal of satirical remarks from sceptical lay public. It is natural -that it should be so, for the science of bacteriology is still in its -infancy, and many of its practical applications are still in their -experimental stage. But undoubtedly the science is advancing, and by its -aid we are now better able to understand diseases and their nature. Many -facts have been demonstrated and proved with precision. What is -disbelieved to-day, may, however, be believed tomorrow, for, with all -human attempt to reveal secrets of nature, such is the case. Readers of -Smollet’s Roderick Random may remember how in the Surgeon’s Hall one of -the examiners said:—“I affirm that all wounds of the intestine whether -great or small are mortal.” Now, however, if a man dies of a wound of -the intestine, the unfortunate doctor in whose hand such a casualty -takes place runs great risk of being charged with malpraxès. - - - - - _TREATMENT._ - - -I. _Hygienic._—The patient should take to bed immediately on the -appearance of the first symptoms. The room should have means for free -ventilation, and the temperature in it should be between 60° to 70° F. -The air of the room may be cooled by a block of ice. The room should be -kept clean, and there must not be in it any curtain, carpet or hangings. -The floor and bedsteads should be daily washed with a disinfectant -solution. A position of absolute rest in bed is to be maintained -throughout the illness. - -Bedpan and urinal should be always used. Bedclothes should be light and -warm. Wearing apparel if saturated with perspiration should be changed. -It is best to have two beds side by side so as to be able to move the -patient easily from one to another for cleansing purposes. Mattresses -should be suitably protected from penetration by the discharges. The air -of the sickroom can be made antiseptic by placing pieces of blotting -paper saturated with eucalyptus oil or phenol on plates about the -apartment or by pouring carbolic acid on hot water in a plate. The -doorways should be curtained by a sheet wet with disinfectant solution. -Great cleanliness of the body of the patient should be enforced by cold -sponging with an antiseptic solution. Skilful nursing is essentially -necessary. The motions should be disinfected by strong antiseptics such -as quicklime, carbolic acid, &c., as soon as they are passed. - -II. _Dietetic._—From the commencement of the disease the diet should be -liquid and nourishing. Milk is best. The quantity for adults should not -be less than three or four pints in the twenty-four hours. It must be -given in small quantities at short intervals. Soda, potash or plain -carbonated water may be mixed with it. Barley water and thin sago water -may also be given. If the patient’s vital powers are low, the milk may -be peptonised by using Fairchild’s powders or by adding a little of -Benger’s Liquor Pancreatices. In cases when milk cannot be taken in -sufficient amount, animal food may be given in the form of plain meat -broth. Egg-flip with or without brandy may also be given. It is useless -to give strong meat essences when the digestive powers are seriously -impaired, and excess of zeal in this direction does a great deal of -harm. These accumulate in the intestinal canal and form a fermenting -mixture in which poisonous ptomaines form. Throughout the attack the -patient’s strength should be husbanded as carefully as possible. When -there is thirst, water, or iced water, or iced beer or stout, or -ice-cream, or fruit _sherbat_ should be given. During convalescence -great care should be taken of diet, for then the vital powers are at a -very low ebb. - -III. _External._—In order to lower the temperature rubbing of the skin -with oil from the commencement of the disease has been recommended, but -this procedure is, I think, of no use. I suggest, however, that when -temperature is high 15 drops of Creosote may be rubbed near the axilla. -During height of fever, the body may be lightly sponged all over, twice -or thrice a day, with the following solution:— - - Thymol 40 grains. - Spirit Lavendula 2 oz. - Spirit Vin. rectif. 3 ” - Acid Acetic dil. 3 ” - Aquæ Rose add 16 ” - -Mustard plasters to limbs and over the heart should be given when there -are signs of failing heart and circulation, and over the epigastrium -when there is vomiting or hiccough. Smelling salts and strong ammonia -should be applied to the nostrils for their restorative action. Blister -over the nape of the neck is useful when cerebral symptoms are present. -Ice caps over the head is very useful and should be applied -continuously. The enlarged glands may be fomented with hot water or -spongio-piline wrung out of hot antiseptic solution. When they are much -painful, poppy or belladonna may be added to the water. Belladonna with -glycerine should be applied in the beginning and iodine afterwards. Hot -corrosive sublimate fomentations are also useful. If the glands -suppurate, they should be opened aseptically and dressed with -antiseptics. Proper drainage should be provided. - -IV. _Internal._—Knowing as we do that the plague is due to the toxic -products metabolized by a pathogenic bacillus, the question comes—would -an antiseptic treatment be of any use? Can we by any means induce an -antiseptic action on the blood, or have we any drug which can act as -antitoxin? It must be at once stated that no drug that has been tried -yet fulfils the above conditions. The claims of quinine, however, should -be taken into account. This drug in small repeated doses acts as a -general antiseptic. I would, therefore, advocate its use especially in -the early stages. Plague is a disease in which collapse sets in early -and cardiac asthenia is a very early complication. There is, therefore, -great urgency for early stimulation. Alcohol may be given freely, but at -the same time it must be remembered that if the organs of elimination -are not acting properly, alcohol may do harm. For their stimulant -effects whiskey or iced champagne may be given. Carbonate of ammonia or -spirit ammonia aromatic are held to be very useful stimulants in plague -cases. They may be given in combination with cinchona, digitalis and -ether. A prescription like the following may be useful:— - - Ammonia Carb. 5 grains. - Chloric Ether 20 minims. - Sulphuric Ether 15 ” - Tint. Digitalis 5 ” - Tint. Cinchona 1 dram. - Aquæ Camphor 1 ounce. - Every three hours. - -For cardiac asthenia, the following may be tried:—(1) Caffeine, -hypodermically, 5-grains dissolved by the aid of 5 grains of Sodium -Benzoate in 20 minims of warm distilled water and injected three or four -times a day if needful; (2) Ether or ethereal solution of camphor -hypodermically; (3) Strychnine, hypodermically, beginning with gr. 1/60 -every four or six hours till gr. 1/16 is injected, or Liquor Strychnia -in 5—10-minim doses every four hours; (3) Musk may be given in 5-grain -doses, or as in the following mixture:— - - Pulv. Moschi 10 grains. - Mucilage Acacia 2 drams. - Syr. Aurantii 2 ” - Aquæ Camphor ½ ounce. - To be given every 6 hours. - -Digitalis does not always give good results, a fact which Lowson -attributes to some inflammatory or fatty degenerative changes in the -small vessels giving rise to a tendency to hæmorrhage. Stropanthus may -be substituted. Transfusion of blood a hot saline solution and -inhalation of oxygen have been recommended for collapse. Dr. Viegas of -Bombay recommends Liquor Hydrasgyie Perchloride 10 to 15 minims every -four hours if there is no albumen in the urine. Dr. Dimmock has advised -subcutaneous injection of Guaicol 10 or 15 minims every two hours. -Permanganate of Potash 5 to 12 grains in 24 hours has also been -recommended. Dr. Blaney has recommended Medritina in two-dram doses -every two hours when the kidneys are involved. Camphor has been -recommended by some as a cardiac stimulant. - - - - - _TREATMENT OF SYMPTOMS._ - - -(1). High temperature may be reduced by antipyretics, such as antipyrin, -phenacetin, antifebrine, &c. These drugs produce profuse perspiration -and a certain amount of depression; it is, therefore, advisable to -restrict their use during the first few hours only, and if not found -responding, they should be dropped altogether. Pyrexia is but a sign of -the intensity of the activities of the infective agent, and by -artificially reducing the body heat we really do not lessen the -virulence of the poison, as shown by the rise of the temperature again -as soon as the action of the antipyretic subsides. Hyperpyrexia itself -is, however, an injurious symptom, and when there is long continued high -temperature it is necessary to reduce it, either by an antipyretic, -quinine or cold bath, or cold sponging. Cold bath is not suitable in -plague patients on account of the movement of the body which it entails, -and also on account of the serious cardiac depression which accompanies -the disease. Two grains of phenacetin with 1 grain of hydrobromate of -quinine is a safe antipyretic. Brandy and tepid sponging are also very -useful. - -(2). _Brain symptoms._—For headache a mustard plaster behind the upper -part of the neck and over the occiput. Ice cap or Lieter’s tube or plain -water should be applied over the temples and scalp. Nervine sedatives, -such as Potassium Bromide, may be given for insomnia when there is not -much depression. Otherwise full doses of alcohol may be tried. Opium -should not be used, but in mild cases, without great depression, 10 to -20 minims of Liquor Opii sedativus with 30 minims of Sal Volatile in an -ounce of camphor water may be given to soothe nervous unrest. For -insomnia Lowson speaks highly of Morpinæ gr. 1/8 to gr. ½. Hyoscine gr. -1/200 to gr. 1/75 may be tried. Meningites should be treated by cold to -the scalp and counter-irritation to the nape of the neck and occiput. - -(3). _Hæmorrhages_ may be treated by Ergot or Ergotin internally or -hypodermically. When there is much hæmorrhage, use of alcohol should be -partly suspended. - -(4). If there is constipation, a dose of calomel may be given. In the -beginning there is almost always constipation, which should be removed -by a dose of calomel followed by a saline. Diarrhœa may be checked by an -enema of opium. Two grains of Dover’s powder and 10 grains of tannin -mixed with an ounce of gum mucilage and with two or three ounces of warm -water, arrowroot or starch may be used for injection. Salol in 10-grain -doses every 4 hours may be given for diarrhœa. For vomiting and hiccough -sinapism over the epigastrium, sucking of ice, and for thirst acidulated -water with syrup of lemon are recommended. Coma must be promptly met by -cold effusion if there is pyrexia or by rectal injection of strong -coffee. The bladder of the patient should be carefully watched. -Pneumonia and other complications should be treated under general -principles. - -When temperature falls and convalescence begins, the stimulants should -be lessened, and afterwards a tonic with quinine, acid nitromuriatic -dil., tincture calumba or quassia may be given with infusion aurantii. - -_Serum treatment._—The whole system of serum therapeutics is due to the -genius of Pasteur. Diphtheria and tetanus are diseases that are caused -by specific germs and are now successfully treated by immunised serum. -Tetanus can be prevented and even cured by the injection of serum of -other animals vaccinated against this disease: this process has been -applied by Yersin for producing a plague serum, for which a prophylactic -and curative power is claimed, and this serum may be called plague -antitoxin. Yersin treated his first case in Canton. At Amoy, the people -were less averse to treatment, and in 10 days he was able to treat 23 -with two deaths only. As yet Yersin’s serum has been tried in the -declared diseases, but Yersin also proposes to use it as a preventive. -Haffkine also proposes to make use of his serum for curative purpose. -Yersin’s serum is older than Haffkine’s, otherwise bacteriologically -they are identical. The subject is in far too unsettled a condition at -present, but it has no doubt a hopeful future before it. - - - - - _DISINFECTION._ - - -Substances which can prevent infectious diseases from spreading by -destroying their specific germs are called disinfectants. These -disinfectants can kill pathogenic germs. Heat is a most powerful agent -in killing-germs, therefore anything which is subjected to prolonged -boiling becomes sterile or germ-free. For purification of clothes and -bedding, heat is the best agent, either by boiling them in water or by -placing them in a hot-air chamber. The usual arrangement is a furnace -with the smoke shaft passing under or on one side of a brick chamber and -with a hot-air blast from a shaft running through or under the fire into -the chamber itself, or into a passage below it, whence it passes into -the chamber through a valve; an exit for the hot-air is provided at the -top of the chamber, the clothes are suspended in the chamber, at a -little distance from the walls. Various kinds of ingenious apparatus -have been recently contrived and are used. Steam disinfecting chambers -are necessary for the disinfection of clothes, &c., of a large -population, and all large towns and railway stations should have them. -High pressure steam in an apparatus contrived for the intermission of -its pressure is found to give the best heat penetration to large -non-conducting articles such as bedding. Fumigation by burning sulphur -or chlorine is a very useful method for disinfection of rooms. Large -bonfires of sulphur may also have a beneficial effect on the air. - - - - - _PURIFICATION OF A ROOM AFTER PLAGUE CASES_— - - -All woodwork should be thoroughly cleansed with soft soap and water, to -which a little carbolic acid has been added. The walls should be scraped -and then washed with hot lime to which carbolic acid should be added in -the proportion of one pint to four gallons of water. Then the room -should be fumigated for 3 hours, with all doors and windows and the -chimney being closed, sulphur about 1 seer for every 100 cubic feet of -space should be put in a metallic dish, a little alcohol is poured on -it, and it is lighted. After 3 hours the doors and windows should be -opened and kept open for 24 or 36 hours. Rooms may be disinfected by -chlorine. Carbolic acid in 5 per cent. solution is useful for all -ordinary purposes, such as washing hands, utensils, &c. - -Quicklime is the cheapest and the most easily procurable disinfectant -for drains and for disinfection of discharges. Carbolic powder made by -adding carbolic acid to lime is very useful for the disinfection of -public latrines, drains and sewers. Corrosive sublimate, in the -proportion of 1 part in 4,000, is the most efficient germicide known and -should be used diluted with water for sprinkling on public roads and for -flushing drains and washing latrines, &c. It is, however, poisonous and -corrodes metal drain pipes. In quarantine or isolation camp the latrines -should be of the dry earth system. Carbolic acid powder should be -largely used in them. The question of suitable disposal of sewage -depends on the circumstances of each town or village, but incineration -is the most sanitary method during an epidemic. Other disinfectants too, -such as Jey’s Fluid, Creoline, Phenyle, Izal, Sanitas, may also be used. - - - - - Transcriber’s Notes - - -—Silently corrected a few typos. - -—Retained publication information from the printed edition: this eBook - is public-domain in the country of publication. - -—In the text versions only, text in italics is delimited by - _underscores_. - - - - - - - -End of the Project Gutenberg EBook of The Bubonic Plague, by A. 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} -.fndef, p.fn { text-align:justify; margin-top:1.5em; margin-left:1.5em; text-indent:-1.5em; } -.fndef p.fncont, .fndef dl { margin-left:0em; text-indent:0em; } -.fnblock div.fncont { margin-left:1.5em; text-indent:0em; margin-top:1em; text-align:justify; } -.fnblock dl { margin-top:0; margin-left:4em; text-indent:-2em; } -.fnblock dt { text-align:justify; } -dl.catalog dd { font-style:italic; } -dl.catalog dt { margin-top:1em; } -.author { text-align:right; margin-top:0em; margin-bottom:0em; display:block; } - -dl.biblio dt { margin-top:.6em; margin-left:2em; text-indent:-2em; text-align:justify; clear:both; } -dl.biblio dt div { display:block; float:left; margin-left:-6em; width:6em; clear:both; } -dl.biblio dt.center { margin-left:0em; text-align:center; text-indent:0; } -dl.biblio dd { margin-top:.3em; margin-left:3em; text-align:justify; font-size:90%; } -p.biblio { margin-left:2em; text-indent:-2em; } -.clear { clear:both; } -p.book { margin-left:2em; text-indent:-2em; } -p.review { margin-left:2em; text-indent:-2em; font-size:80%; } -p.pcap { margin-left:0em; text-indent:0; text-align:center; margin-top:0; } -p.pcapc { margin-left:4.7em; text-indent:0em; text-align:justify; } -span.attr { font-size:80%; font-family:sans-serif; } -span.pn { display:inline-block; width:4.7em; text-align:left; margin-left:0; text-indent:0; } -</style> -</head> -<body> - - -<pre> - -The Project Gutenberg EBook of The Bubonic Plague, by A. Mitra - -This eBook is for the use of anyone anywhere in the United States and most -other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms of -the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you'll have -to check the laws of the country where you are located before using this ebook. - -Title: The Bubonic Plague - -Author: A. Mitra - -Release Date: August 15, 2020 [EBook #62931] - -Language: English - -Character set encoding: UTF-8 - -*** START OF THIS PROJECT GUTENBERG EBOOK THE BUBONIC PLAGUE *** - - - - -Produced by deaurider, Stephen Hutcheson, and the Online -Distributed Proofreading Team at https://www.pgdp.net (This -file was produced from images generously made available -by The Internet Archive) - - - - - - -</pre> - -<div id="cover" class="img"> -<img id="coverpage" src="images/cover.jpg" alt="The Bubonic Plague" width="780" height="1201" /> -</div> -<div class="box"> -<h1>THE BUBONIC PLAGUE.</h1> -<p class="tbcenter"><span class="smallest">BY</span> -<br />A. MITRA, <span class="smaller">L.R.C.P., L.R.C.S., F.C.S.</span>, -<br /><i class="small">Chief Medical Officer, Kashmir.</i></p> -<p class="tbcenter">Calcutta: -<br />THACKER, SPINK AND CO., -<br /><span class="small">5 & 6, <span class="sc">Government Place</span>.</span> -<br /><span class="smaller">1897.</span></p> -</div> -<h2 id="toc" class="center">CONTENTS.</h2> -<dl class="toc"> -<dt class="small"><span class="sc">Page</span></dt> -<dt><a href="#c1"><span class="sc">What is it?</span></a> 1</dt> -<dt><a href="#c2"><span class="sc">Its History</span></a> 1</dt> -<dt><a href="#c3"><span class="sc">The London Epidemic of 1865</span></a> 3</dt> -<dt><a href="#c4"><span class="sc">Geographical Distribution</span></a> 8</dt> -<dt><a href="#c5"><span class="sc">Causes</span></a> 8</dt> -<dt><a href="#c6"><span class="sc">Bacillus</span></a> 9</dt> -<dt><a href="#c7"><span class="sc">Contagious as well as Infectious</span></a> 11</dt> -<dt><a href="#c8"><span class="sc">Nature of an Epidemic</span></a> 13</dt> -<dt><a href="#c9"><span class="sc">Incubation</span></a> 17</dt> -<dt><a href="#c10"><span class="sc">Symptoms</span></a> 17</dt> -<dt><a href="#c11"><span class="sc">Varieties</span></a> 21</dt> -<dt><a href="#c12"><span class="sc">Diagnosis</span></a> 21</dt> -<dt><a href="#c13"><span class="sc">Prognosis</span></a> 23</dt> -<dt><a href="#c14"><span class="sc">Microscopic and Macroscopic Appearances</span></a> 24</dt> -<dt><a href="#c15"><span class="sc">Prevention</span></a> 24</dt> -<dt><a href="#c16"><span class="sc">Sanitary Measures by Municipal Authorities</span></a> 26</dt> -<dt><a href="#c17"><span class="sc">Private Hygiene</span></a> 29</dt> -<dt><a href="#c18"><span class="sc">Inoculation against Plague</span></a> 32</dt> -<dt><a href="#c19"><span class="sc">Treatment</span></a> 33</dt> -<dt><a href="#c20"><span class="sc">Treatment of Symptoms</span></a> 38</dt> -<dt><a href="#c21"><span class="sc">Disinfection</span></a> 40</dt> -<dt><a href="#c22"><span class="sc">Purification of a Room after Plague Cases</span></a> 41</dt> -</dl> -<div class="pb" id="Page_1">1</div> -<h1 title="">THE BUBONIC PLAGUE.</h1> -<h2 id="c1"><span class="small"><i>WHAT IS IT?</i></span></h2> -<p>Any contagious and fatal epidemic disease was -originally called a plague (from <i>plaga</i>, a stroke), -but this term is now applied to that particular kind -of plague which is characterised by the appearance -of high fever with inflammation of lymphatic glands -or bubo, and is therefore called the Bubonic Plague. -In Sanskrit Medical Books it has been described as -<i>Vidradhi</i> and <i>Visharpa</i>, and in Yonani as <i>Taoon</i>. -The following definition given by Cantlie is comprehensive. -“Plague or Malignant Polyadenites is -an acute febrile disease of an intensely fatal nature -characterised by inflammation of the lymphatic -glands, marked cerebral and vascular disturbances, -and by the presence of a specific bacillus.”</p> -<h2 id="c2"><span class="small"><i>ITS HISTORY.</i></span></h2> -<p>It is an ancient disease mentioned in Hindoo -and Christian Scriptures. Long before the Christian -era it prevailed in Greece, attacking the town of -Piræus, where it raged for two years. Egypt, Syria, -Constantinople and Rome were visited by the plague. -In Constantinople the outbreak was once so furious -that during three months from 5,000 to 10,000 -deaths occurred daily. The first historical allusion -to plague was made by Rufus, a physician who -lived in the reign of Trajan (A.D. 98-117), and -who mentions of glandular swellings. In 1347, plague -appeared in almost all countries in Europe, where -<span class="pb" id="Page_2">2</span> -Hecker believes, 25 millions of persons perished. -Ireland was visited by plague three hundred years -after its invasion by Patrolan, and it is said that -9,000 people died in a week and were buried at -Tallagh near Dublin—a name which means the -burial place of the plague-stricken. Plague visited -England frequently, and no fewer than eighteen -epidemics are said to have occurred before the great -plague of 1665. In 1720, 40,000 out of a population -of 90,000 died at Marseilles. In 1751, 150,000 -died of plague in Constantinople. In 1799 the -French Army in Syria was devastated by plague. -6,000 persons died in Malta in 1813. In 1834-35, -14,888 persons died in Alexandria out of a population -of 42,000. In 1876 there was an outbreak -of the disease at Kumaon in Northern India, where -it prevailed several times during the present century, -and where it is known as the <i>Maha-Mari</i>. -It is also said that it prevailed in 1815 on the -Island of Kutch, and lasted till 1821 in Kutch and -Sindh. It also occurred between the years 1828 -and 1838 in Jhansi, Bareilly, Pali and Jodhpore. -In China the plague has been present for a long -time in an epidemic form. In 1894 60,000 persons -died at Canton. From Canton it spread to Hongkong -and to Amoy. In 1895, it visited many places -in Southern China. In 1896, it was present at -Hongkong. Some people think that the disease -has come to Bombay probably from Singapore. -There was an epidemic at Merv when the Bombay -outbreak appeared, others, however, think that the -epidemic at Merv was not that of plague and that -the disease has come from Hongkong.</p> -<div class="pb" id="Page_3">3</div> -<h2 id="c3"><span class="small"><i>THE LONDON EPIDEMIC OF 1665.</i></span></h2> -<p>The following graphic and interesting account -of the great London Epidemic of 1665 is taken from -Sir William Guy’s book on “Public Health.”</p> -<p>“I now turn for a more exact account of the -plague of 1665 to the work of Dr. Nathaniel Hodges, -a Fellow of the College of Physicians, resident in -the City, and, as his book shows, in active practice -among the victims of the disease.</p> -<p>“Dr. Munk, in his roll of the Royal College -of Physicians of London, says that he ‘acquired a -great name among the citizens of London; that he -remained at his post and continued in unremitting -attendance on the sick,’ and that ‘during the latter -part of his life he received a regular stipend from -the City of London for the performance of his -charitable office.’</p> -<p>“Dr. Hodges tells us that about the close of -1664, two or three persons died suddenly with -symptoms of the plague in one family at Westminster, -that some timid neighbours of theirs took -fright and removed into the City of London carrying -the taint of pestilence with them whereby the -disease, which existed only in a family or two, gained -strength and spread abroad, and ‘for want of confining -the persons first seized with it, the whole -city was in a little time irrecoverably infected.’</p> -<p>“In December a hard frost set in, which lasted -three months, and during that time very few died -of the plague. But the disease was not extinguished; -for, in the middle of the Christmas holidays, the -doctor was called to a young man in a fever, who -after two days ‘had two risings about the bigness of -<span class="pb" id="Page_4">4</span> -a nutmeg,’ ‘one on each thigh,’ with a ‘black hue’ -and a ‘circle round them.’ By these and subsequent -symptoms, he judged it to be a case of plague. It -did not prove fatal.</p> -<p>“When the frost broke, the disease gained -ground and extended into several parishes; and -the authorities issued an order ‘to shut up all the -infected houses,’ so as to prevent ingress and egress. -To give effect to this order, the houses of the infected -were to be marked with a red cross, and to -carry the inscription, ‘<i>Lord have mercy upon us</i>,’ -and a guard was set whose duty it was to hand food -and medicine to the sick, and to prevent them from -going abroad till forty days after their recovery. -In spite of these harsh measures, ‘the plague -more and more increased.’ Nor will this surprise -us if we imagine the frantic and successful efforts -that must have been made by the non-infected to -escape, and the temptation to servants and nurses -to appropriate and remove the property of the -dying and dead. Indeed, Dr. Hodges accuses the -nurses of strangling their patients, and secretly -conveying the pestilential taint from sores of the -infected to those who were well; and he justifies -his accusation of ‘these abandoned miscreants,’ the -Gamps and Prigs of the seventeenth century, by -two instances; the one of a nurse who, ‘as she -was leaving the house of a family, all dead, loaded -with her robberies, fell down dead under her burden -in the streets,’ the other of a ‘worthy citizen’ -‘who, being suspected dying by his nurse, was -beforehand stripped by her; but recovering again, -he came a second time into the world naked.’</p> -<div class="pb" id="Page_5">5</div> -<p>“In spite of the well intentioned measures of -the authorities, the plague continued through May -and June with more or less severity, sometimes -in one place, sometimes in another, till the people -becoming thoroughly frightened, flocked out of -town in crowds. But the disease raged with redoubled -fury among those that remained. Then -the authorities bestirred themselves to the utmost. -They instituted a monthly fast; and the King commanded -the College of Physicians ‘to write somewhat -in English,’ that might serve as ‘a general -directory.’ The college not only obeyed the royal -commands, by inventing a ‘<i>Plague Water</i>,’ consisting -of a cordial distilled off from a vinous infusion of -a score of very harmless roots, leaves, and flowers, -but also appointed two of their number to co-operate -with two chosen from among the aldermen -in attending the infected; while Dr. Glisson, Regius -Professor at Cambridge, and Drs. Paget, Wharton, -Berwick and Brookes volunteered their help, with -many others who survived, and eight or nine who -fell victims to their self-devotion, among whom -Dr. Conyers receives honourable mention.</p> -<p>“Still, in the face of every precaution, the -plague continued its work of destruction, especially -among the common people, so as to be called the -‘<i>Poor’s Plague</i>,’ and, in August and September, -completely got the mastery, ‘so that three, four or -five thousand died in a week, and once 8,000.’</p> -<p>“And here I will follow Dr. Hodges’ example, -and try to give you some idea of the state of things -then prevailing. But in doing so I must shorten -and tone down his description. ‘In some houses,’ -<span class="pb" id="Page_6">6</span> -he says ‘carcases lay waiting for burial,’ ‘in others, -persons in their last agonies.’ ‘In one room might -be heard dying groans, in another the ravings of -delirium,’ and, near at hand, relations and friends -bewailing their loss and their own dismal prospects. -‘Death was the sure midwife to all children, and -infants passed immediately from the womb to the -grave.’ Some of the infected ran about staggering -like drunken men, and fell down dead in the streets, -or they lay there comatose and half dead; some -lay vomiting as if they had drunk poison; others -fell dead in the market in the act of buying provisions. -The plague spared ‘no order, age or sex.’ -The divine was taken in the very exercise of his -priestly office, and the physician while administering -his own antidote; and though the soldiers retreated, -and encamped out of the city, the contagion -followed, and vanquished them. Many in -their old age, others in their prime, most women -and still more children, perished; ‘and it was not -uncommon to see an inheritance pass successively -to three or four heirs in as many days.’ There -were not sextons enough to bury the dead, the bells -ceased tolling, the burying places were full, so that -the dead were thrown into large pits, dug in waste -ground, in heaps 30 or 40 together; and those who -attended the funerals of their friends one evening -were often carried the next to their own long home.</p> -<p>“This is written of a time when the worst had -not yet happened. It was about the beginning of -September that the disease was at its height. Then -fires were ordered to be burnt in the streets for -three days together; but before the time had expired, -<span class="pb" id="Page_7">7</span> -they were extinguished by heavy rains, which -ushered in the most fatal night of all with its -register of more than 4,000 deaths.</p> -<p>“From this, its culminating point, the plague, -‘by leisurely degrees declined,’ ‘and before the -number infected decreased, its malignity began to -relax, insomuch that few died, and those chiefly such -as were ill-managed.’ Dr. Hodges distinctly states -that the pestilence did not stop for want of subjects, -but from the nature of the distemper. ‘Its -decrease was, like its beginning, moderate.’ Early -in November, people grew more healthful, and -though the funerals were still frequent, ‘yet many -who had made most haste in retiring, made the -most to return;’ ‘insomuch that in December, they -crowded back as thick as they fled.’ The houses -were again inhabited; the shops re-opened; the -people went cheerfully to their work; the rooms, -in which a short time before infected persons had -breathed their last, were peopled afresh, and many -went into their beds ‘before they were even cold -or cleansed from the stench of the diseased.’ ‘They -had the courage now to marry again,’ ‘and even -women, before deemed barren, were said to prove -prolific, so that, although the contagion had carried -off, as some computed, about 100,000, after a few -months, their loss was hardly discernable.’ But the -next spring there appeared ‘some remains of the -contagion,’ which was easily conquered by the physicians; -and the whole malignity ceasing, the city returned -to perfect health, as after the great fire, ‘a new -city suddenly arose out of the ashes of the old, much -better able to stand the like flames another time.’”</p> -<div class="pb" id="Page_8">8</div> -<h2 id="c4"><span class="small"><i>GEOGRAPHICAL DISTRIBUTION.</i></span></h2> -<p>Plague is known in Europe, Asia and Africa, -but it has not been known in the Western Hemisphere. -It is said that Mesopotamia is the home -of plague. It has been known as far North as -Astrakhan in Asia and Norway in Europe. During -the last fifty years, however, it is chiefly confined -to Asia from Red Sea on one side, and the shores -of the Pacific on the other. Some are inclined to -think that the plague was carried from Himalyan -India across Thibet to Yanon in Chinese territory, -thence to Pekoi whence it made its way to Canton -and Hongkong. If that be so, then the plague has -accomplished a tour from Northern India <i>viâ</i> China -by Sea route to Southern India within a period of -twenty years between 1876 and 1896.</p> -<h2 id="c5"><span class="small"><i>CAUSES</i>—</span></h2> -<p>A disease so fatal in its nature and against -which human power is so futile was in ancient -times naturally attributed to wrath of the gods. -Supernatural, astrological, and, in some instances, -rationalistic causes were assigned to it. In the -fourteenth century the College of Physicians of -Paris ascribed it to the influence of constellations -in India. But more natural explanations, however, -gradually followed. Putrefaction of dead animals -was assigned as a cause in Egypt. Poisoning of -water-supply was also believed to be the cause. -Undue heat, rain, watery grain, and absence of the -Etesian winds were thought to generate plague. -Leaving ancient theories on the causation of the -disease we find that modern Scientists divide themselves -into two classes: <i>first</i>, those who believe in -<span class="pb" id="Page_9">9</span> -the germ theory and attribute the plague to a -specific germ, holding that germs can never arise -<i>de novo</i>; <i>second</i>, those who believe that atmospheric -changes and certain telluric conditions or -insanitary surroundings engender the seeds of -pestilence which are carried through air, water or -other media. The arguments in favour of the first -theory are, however, so strong and overwhelming, -that it is now almost universally accepted that -plague is due to a specific poison which grows and -multiplies under favourable conditions, and that -wherever it occurs it is caused by the implantation -of those germs in a suitable soil. If the soil is -not fit, the germs may be sown, but they will not -germinate and, if the soil is fit but the germs are -absent, the disease will not be seen. The soil best -suited for the plague seed is one where insanitary -conditions prevail. Dirt and filth, bad ventilation, -and overcrowding are its manure. The history of -plague from ancient times fully illustrates that -plague thrives in dirt, filth, squalor and misery. -Diseased grain and want of subsoil drainage are -held to be potent factors in the diffusion of plague.</p> -<h2 id="c6"><span class="small"><i>BACILLUS</i>—</span></h2> -<p>During the Hongkong epidemic the great Japanese -bacteriologist Kitasato, who formerly worked -with Koch in Germany, discovered a bacillus in -plague-stricken patients, and showed by experiments -that these bacilli if injected into lower animals produced -in them symptoms of plague. Yersin simultaneously -discovered the same germs in connection -with plague. According to our modern notion of -the causation of the disease, these germs must be -<span class="pb" id="Page_10">10</span> -considered to be the specific poison which produces -the symptoms of plague. The bacilli are found in -the blood, in the buboes, and in all internal organs -of the victim of the plague. They are short rods -with rounded ends, with a clear space or band in -the centre, readily stained by the aniline dyes and -showing very little power of movement. The size -of the plague bacillus varies, and bacilli of same -character, but of less virulent nature, have been -found in the soil of infected places. Some bacteriologists -observed some development after death in the -bacilli, this, if confirmed by observations at Bombay, -will be highly interesting from a bacteriological point -of view. If mice, rats, guinea-pigs and rabbits are -inoculated with the plague bacillus, they soon become -infected and die, and in their internal organs the -same bacilli are found. They are also found in the -soil and dust of houses where plague patients were -kept, but not invariably so. Kitasato found the -bacilli in the blood of patients convalescing from an -attack of plague even three or four weeks after -all symptoms have disappeared. It has been found -that the bacillus dies after four days, during which -it is kept at a dry heat, or at the temperature of -80°C. or 176°F. for half an hour, or at that of 100° -C or 212°F. for a few minutes. Its resisting power to -chemical disinfectants is feeble, dying in a 1 per cent. -solution of carbolic acid or of lime water. It develops -easily in many culture media at the ordinary -temperature (from 18° to 22°C). An alkaline solution -of Peptone 2 per cent., with from 1 to 2 per -cent. of gelatine, is the best nutrient medium for -its cultivation.</p> -<div class="pb" id="Page_11">11</div> -<h2 id="c7"><span class="small"><i>CONTAGIOUS AS WELL AS INFECTIOUS.</i></span></h2> -<p>Experience has proved that plague can be -transmitted from one person to another by direct -contact; when a case of plague occurs in a house, -other inmates of the house are much liable to be attacked -also. Visitors to the house, medical and other -attendants are also liable to be seized or to carry -with them fresh focus of infection. It was, however, -found in the Hongkong epidemic of 1894 that none -of the European medical men, some fifteen in -number, nor any of the Chinese students who were -on duty at the plague hospital died. During the -Egyptian epidemic of 1835 a French doctor, Bulard, -with the courage of his conviction that plague was -not contagious wore the shirt of a patient who died -from plague, and yet did not contract the disease. -Such immunity, however, was probably due to some -circumstances which might be easily explained. In -the Hongkong epidemic of 1894 three Japanese -medical men contracted the disease, and in 1896, -some European nurses were attacked. In Bombay -the sad deaths of Surgeon-Major Manser and Miss -Joyce prove that contagion plays an important part -in the spread of the disease.</p> -<p>It has been maintained that plague is a miasmatic -or soil-bred disease, and that the germs find -in earth, water or in some form of fermenting or -decomposing material a suitable nidus for growth. -In this sense it is like malaria, which is endemic -in a particular suitable area appearing and disappearing -according as climatic or other conditions -are favourable or unfavourable. The Chinese -have a peculiar idea of the infection of plague. -<span class="pb" id="Page_12">12</span> -They consider that the plague rises from the soil and -believe that it first attacks small animals with breathing -organs near the soil, such as rats, then animals -with breathing organs a little higher, such as poultry, -pigs, dogs, goats, cows, so on till it reaches man, -whose breathing organs are higher from the soil than -those of other animals.</p> -<p>The rats are undoubtedly attacked with plague -before and during its prevalence among human -beings, and they play an important part in the spread -of its infection. In Kumaon this rat plague was -observed by the people, and was recognized as a -forerunner of the plague. The <i>Times of India</i>, -September 30th, 1896, contains the following:—“It -was known more than a month ago to all the -people of Mandavi and to all the municipal sweepers -in the district that the rats were dying in -thousands all over the districts. They were found -dead and dying almost everywhere, and in places -where dead rats were never found before.” In -Bombay an instance has been reported of a man -trampling with bare foot on a rat which was -seen slowly passing in a room and getting attacked -by the plague soon after. Pigs, dogs, snakes, -and jackals are said to be also affected by the plague. -It will be seen that flesh-eating animals are the -sufferers, due evidently to their eating plague flesh. -Snakes swallow rats, and rats become infected by -consumption of poisoned material or from infected -soil or by their cannibal habit. Like other diseases -due to a specific germ, the infection of plague may -be caught from various sources such as the following—(<i>a</i>) -By means of breath. Plague dust and dirt -<span class="pb" id="Page_13">13</span> -are very potent infective agents. A man getting -a whiff of dust from the floor of a room in which -there is a plague patient blown into his face may -get the infection. Sweepers and others engaged in -conservancy are, therefore, easily attacked. (<i>b</i>) By -food or drink. Grain adultered with sand or earth -infected by rats may be a source of infection. Food -may also be infected by flies or diseased rats (<i>c</i>) By -direct inoculation through any abrasion in the skin -or mucous membrane. People with bare feet are, -therefore, more liable to catch the infection. The -infection may be spread by infected linen, bedding, -furniture and fomites. The discharge from buboes -contains the germs, and is, therefore, highly poisonous. -The fæces, the urine, the sputum, the fur on the -tongue are also infective. If the theory be true that -the poison attaches itself to the soil, then persons -living on ground-floor are more liable to the infection, -and a floating population less so. Dust laden -with germs is the principal agent in the diffusion of -plague as that of any other germ disease. Professor -Aoyama of Tokyo, whilst making a <i>post-mortem</i> examination, -scratched the left third finger and was -attacked with the plague, also Dr. Ishigami, assistant -to Kitasato.</p> -<h2 id="c8"><span class="small"><i>NATURE OF AN EPIDEMIC.</i></span></h2> -<p>Plague is a very slow disease; it takes some -weeks to travel from one quarter of a city to -another. It took nine months to travel from the -city of London to Soho, and ten from Hongkong -to Macao—a distance of 30 miles. Thousands of -persons from Canton and Hongkong sought shelter -at Macao, and there was free communication between -<span class="pb" id="Page_14">14</span> -these places, still Macao became affected nine months -after plague ceased at Hongkong. When plague -is first imported in a place, for three or four weeks -isolated cases occur in one neighbourhood. An -epidemic may last only a few weeks or months, but -may extend over several years in sporadic form and -a recrudescence takes place abruptly. In Mesopotamia -plague declines and becomes dormant with -the setting in of the hot weather, its activity reawakening -in winter and gathering force with the -advancing spring. The same was the case in -Egypt. In Constantinople, on the contrary, as well -as in England, the disease was dormant during the -cold months but became active during the hotter. -In England, September was the month of greatest -prevalence. In the epidemic at Bengazi in 1858 -as well as in Mukai in 1863 famine and plague -were found together. That a water-logged soil -favours famine was illustrated during the epidemic -on the Lower Euphrates in 1867. In Persia and -Arabia many epidemics were self-limited and spontaneously -came to an end after spreading on a certain -area, while, on the other hand, it has been known to -obtain an endemic foot-hold, the virus remaining -from year to year, and, occasionally under the influence -of meteorological or unknown causes, becoming -epidemic among the population.</p> -<p><i>Race.</i>—No race seems to enjoy an immunity -from the plague.</p> -<p><i>Geology and Climate.</i>—Except the new hemisphere -the plague has found congenial soil everywhere. -It thrives as much in high and dry altitudes -as in low-lying places, as much in overcrowded -<span class="pb" id="Page_15">15</span> -towns as in sparsely populated semi-desert -regions. In temperate regions it has been known -to rage in summer, but in Astrakhan it prevailed -when there were several feet of snow on the ground. -On the Volga it prevailed during the severest cold -(1878-79), as well as in the extreme heat of Smyrna -(1735). In Bombay it commenced at the end -of an exceptionally dry season, as it did in South -China. During the Hongkong epidemic the rains -increased it. The increase of the epidemic at -Hongkong with the rains was probably due to the -fact that the rains drove people into infected houses, -instead of sleeping outside, as they did in summer -when the weather was good. It has been said that -plague flourishes in a warm moist atmosphere and -dry hot air kills it, but there are records of plague -thriving in conditions antagonistic to this theory. -A temperature between 60° and 85°F. is said to be -very favourable to it.</p> -<p><i>Sex and Age.</i>—Both sexes are equally liable. -It is said that people between the ages of 10 to 30 -are frequently attacked. But experience shows -that children and old people are alike liable to -attack. In Bombay the disease has occurred most -frequently between the ages of 20 and 30, and the -male sex has suffered more than the female.</p> -<p><i>Occupation.</i>—During one epidemic, water-carriers, -or those who used much water, or who dealt -in oil and fats were found comparatively free; but -this observation cannot be relied upon. Those -whose business requires them to come much in contact -with the sick, and also those who are engaged -in cleaning are naturally more exposed to infection. -<span class="pb" id="Page_16">16</span> -It has been said that one attack generally protects -from a second, which, if it occurs, usually runs a -mild course.</p> -<p><i>Sanitation and Personal Hygiene.</i>—Plague, -germs thrive in filth. Bad hygienic conditions, -over-crowding, insufficient ventilation, and absence -of sunlight in dwelling houses, accumulation of -decomposing organic matter, effluvia from bad -drains, sewer and cesspools are causes that favour -the growth and dissemination of an epidemic -of plague. When it attacks a town, it, therefore, -naturally selects first the poorer classes who live in -ill-ventilated and over-crowded houses. Over-crowding -within dwelling houses is a fertile source of -producing a constitution fitted for the reception of -plague-germs. Such portions of towns where there -is much congestion and over-crowding suffer most. -Scarcity of food favours plague. It has been called -<i>Miseriæ Morbus</i>, or the disease of misery, and the -plague of London was called the “poor’s plague.” -In Kumaon there is the usual custom of keeping -cattle in the lower room of a hut, where a crowd of -cattle stand udder deep in fœtid straw. In one of -the rooms of the upper storey grain is kept, and in -another the whole family sleeps with doors and windows -shut. Such conditions are undoubtedly very -favourable to plague.</p> -<p><i>Predisposition.</i>—Chill and exposure to cold, -indigestion and any other disease producing a debilitated -condition of body, fatigue, overwork, error -of diet, mental emotion, and a terror of attack are -predisposing causes. Catarrhs often predispose an -attack.</p> -<div class="pb" id="Page_17">17</div> -<h2 id="c9"><span class="small"><i>INCUBATION.</i></span></h2> -<p>Or how long does it take for the poison to -develop symptoms after infection: generally three -to six days, but the period may be up to ten days. -The period varies with the virulence of the poison. -The germs, however, remain active outside a host -for a long time. An instance has been reported, -in which a man, after handling some ropes which 20 -years previously had been used in the burial of -plague corpses, took the disease and died of it.</p> -<h2 id="c10"><span class="small"><i>SYMPTOMS.</i></span></h2> -<p>The usual premonitory symptoms are headache, -loss of appetite, a feeling of general depression and -aching of limbs. These symptoms may either be -mild or may appear at once in very aggravated -form; violent headache being usually of an acute -dull character, accompanied by throbbing in the -temples, giddiness, sleeplessness, palpitation, a feeling -of oppression of the chest, even mental delusion -may appear on the first day. The look of the -patient is anxious, pale and cyanosed. The expression -of the face resembles that of a man who has -had no sleep for two or three nights but is being -overpowered with the fatigue consequent to it. -These symptoms are usually ushered in with a rise -in the temperature. Well-marked rigor is usually -not seen, but a slight shiver or chillness is complained -of. Pulse is full, bounding and rapid—130 or more -per minute. Respiration is difficult and accelerated -even to 40 or 50 per minute. Skin is dry and hot, -face puffed, conjunctivæ congested. Sense of hearing -is dull. Speech is thick and faltering. Tongue -is dry and coated with greyish white or dark -<span class="pb" id="Page_18">18</span> -brown heavy fur. Violent thirst is present. Sometimes -Patchiæ appear on the skin. In a few -hours, or a few days after the appearance of the -first symptoms, a swollen gland appears either in -the neck or axilla or groin. The gland most commonly -affected is one or some of the femoral chain. -An inguinal, axillary or a cervical gland may also be -affected. A number of glands may swell at one -time or glands in all the above situations may be -felt painful and swollen. The glands of the neck -are most frequently attacked in children. Pains -in the lower part of the abdomen and along the -spine indicate affection of internal lymphatic glands. -In some cases the first symptom noticed is a -swollen and painful gland, but fever soon manifests -itself. The glandular enlargement may antedate, -coincide with, or follow the rise in temperature. -Sometimes only pain in the gland is complained -of, but no swelling is observed. The -temperature rises gradually and goes up to 104°, -105° or 106° F. In some cases a temperature of -108° was observed. There may be a marked morning -fall and an evening exacerbation, which is a -favourable sign, or the temperature may remain -high persistently. All the above symptoms become -soon aggravated when the second stage or stage -of acute development of the disease appears. Brain -symptoms show themselves. Lowson noticed four -distinct type of brain symptoms—(1) comatose, -when the patient lies paralysed, mind and body; (2) -wildly delirious, when the patient struggles and -fights and still retains a fair command of rational -speech; (3) apathetic, when he lies perfectly quiet -<span class="pb" id="Page_19">19</span> -but is drowsy; (4) convulsive, which condition -occurs when there is inflammation of the meninges -or hæmorrhage in the brain.</p> -<p>In this stage all symptoms of a pronounced -typhoid condition supervene. Tongue becomes -parched and black. Sordes cover the teeth. Gradually -a somnolent condition and low muttering -delirium supervene. In some cases the delirium -is violent and furious, while in others it culminates -in complete stupor and coma. Picking of the bed-clothes, -and subsultus tendinum are common, and -the urine and fæces are passed involuntarily. The -pupils are dilated. The skin is bathed with profuse -perspiration. The pulse is dichrotic and compressible, -and gradually becomes anachrotic and -intermittent till it finally fails. The area of cardiac -dullness is increased and pain in the cardiac region -is complained of. Heart begins to fail rapidly. -The usual complications of this stage are—(1) -meningites; (2) hæmorrhages; (3) severe gastric -disturbance, such as vomiting, diarrhœa, hiccough. -As a rule, constipation is found during the course -of an attack, but diarrhœa, even severe, may appear. -There may be pain in the abdomen. Bladder may -be distended and a catheter may be necessary -to evacuate it. Cystitics often develop. Œdema -of the lungs, pleurisy and pneumonia may also -complicate a case. Hæmaturia, hæmoptysis and -hæmatemesis may be seen. Bronchitis and hypostatic -inflammation may occur. The urine always -shows presence of albumen. Death may take place -from cardiac failure or from any of the above -complications. Death may take place within three -<span class="pb" id="Page_20">20</span> -or four days, though in some virulent cases the -patient dies within twenty-four hours. If the primary -collapse is tided over, there is great chance -of recovery, still deaths often occur of complications -several days after the attack.</p> -<p>In mild cases the second stage is not so severe, -and temperature may fall by lysis or crisis—the -latter being rare.</p> -<p>The glands in the meantime become swollen -and are surrounded by a sero-sanguinous exudation. -The surrounding parts are œdematous. The glands -usually do not suppurate, but they may do so and -slough. The usual course after their enlargement is -one of four: (1) resolution; (2) lengthened period -of enlargement; (3) suppuration; (4) sloughing. -In cases that recover the symptoms gradually take -a favourable turn and recovery is as rapid as the -attack. The fever slackens, the pulse becomes -stronger, the tongue moist and the typhoid symptoms -gradually pass away. The buboes either suppurate -or subside; symptoms of secondary pyaemic -conditions, however, may sometimes develop. Deviations -from the typical course are, however, often -observed. Some cases take an extremely rapid -course, the patient succumbing within from 12 hours -to two days. The duration of the disease varies -between a few hours and a few weeks, but on an -average up to the commencement of the convalescence -it seems to last from 6 to 10 days. During -convalescence the vitality of the issues are very low. -Head symptoms sometimes persist for some time. -Temper is irritable. The sloughing glands often take -a long time to heal. Convalescence is soon established.</p> -<div class="pb" id="Page_21">21</div> -<h2 id="c11"><span class="small"><i>VARIETIES.</i></span></h2> -<p>Just as before an epidemic of cholera visits a -place, it is usual to observe cases of mild diarrhœa, -and indigestion prevailing amongst its population; -so, before plague actually breaks out, it has been -found that cases of buboes and parotites with fever -are commonly observed. Such cases were called -<i>Pestis Minor</i> at Astrakhan. “No one died from the -disease <i>per se</i>, but few people were confined to bed.” -It is not known whether in <i>pestis minor</i> the plague -germs could be found; but presumably not.</p> -<p>Drs. Simpson and Cobb of Calcutta have described -what is called <i>Pestis Ambulans</i>, or an ambulatory -form of plague, in which plague germs have -been found. The commonly accepted types of -plague are (1) Fulminant; (2) Typical; (3) <i>Pestis -Minor</i> (including <i>ambulans</i>). The cause of the -first two is the bacillus discovered by Kitasato, and -they are very fatal, of the third, the cause may be -an allied bacterium less potent to produce toxic -effects on man, and it may come and go but plague -may not break out. In ambulatory form the patient -has slight fever and glandular enlargement, but he -can move about.</p> -<h2 id="c12"><span class="small"><i>DIAGNOSIS</i>—</span></h2> -<p>It is difficult to differentiate a case of true -plague in its early stages from a case of fever with -benign glandular swellings or mumps. The premonitory -symptoms of plague, and even the early -symptoms of the first stage, may be due to many -different diseases and therefore great caution is -needed. It is needless to say how important it is -that such diagnosis should be done with great care, -<span class="pb" id="Page_22">22</span> -specially when plague cases have to be isolated, for -if a case of simple fever with benign lymphadenitis -be brought in close contact with patients suffering -from true plague, it is a serious matter with the -former. A venereal bubo, or scrofulous enlargement -of glands, or enlargement of femoral or inguinal -gland due to traumatic or other causes which -may be attended with fever should not be mistaken -for a plague symptom. A medical man who has, -however, carefully observed the facies of a few -cases of true plague, and who carefully takes into -consideration all other probable conditions which -may be mistaken for plague, may not commit a -mistake, but its probabilities are to be borne in -mind. The practical lesson is, that all doubtful -cases should be isolated and kept separate from -cases of pronounced type. The plague bears some -resemblance to typhus. Murchison says: “Plague -is perhaps the typhus of warm climates, the two -diseases being generated from similar causes and -differing only in intensity from the effects of -climate and other collateral circumstances.” In -typhus there is a characteristic rush, and in plague -there is bubo, but this order of things have been -found in some instances to have changed, there -being eruption in plague and bubo in typhus. The -two diseases are, however, different and bacteriological -and clinical evidence corroborate this view. -Cantlie adds another disease, which he says he -mistook for plague:—“On June 26th, 1894, when -the plague was at its height, I saw a Parsee patient -dwelling in a house in which plague existed, suffering -from fever 104°(F.), dry tongue, headache, -<span class="pb" id="Page_23">23</span> -backache and large swollen glands in the left groin, -which had suddenly appeared. Plague seemed the -only diagnosis, and the man, much against his will, -was sent to the plague hospital. In two days he -came back again quite well, and on examining him -I found his urine thick and milky. That night I -found filaria in the man’s blood, and knew I had -made a mistake in the first instance. Of course, -the mistake is most likely to happen, but nevertheless -it is not pleasant to think that we had subjected -the man to the terrible danger of plague infection.”</p> -<h2 id="c13"><span class="small"><i>PROGNOSIS.</i></span></h2> -<p>The mortality from plague may be about 90 per -cent. or more when the epidemic is at its height. In -the beginning, or towards the end of the epidemic, the -mortality is less, as it is the case with all other epidemic -diseases. The average mortality at Bombay -has been 84 per cent. and in Karachi 89 per cent. -It is, therefore, more fatal than all other epidemic -diseases, the mortality from cholera during the -height of an epidemic being about 60 per cent.</p> -<p>In children and in the aged the disease is -more fatal than in healthy adults. Cases in which -the bubo appears early and is single, or in which -there is a distinct morning remission, or less general -prostration or free perspiration, or in which there is -no diarrhœa, have greater chance of recovery. -Rapid suppuration of the buboes indicates a favourable -termination. Buboes do not suppurate as a -rule until the primary fever has fallen. On the -other hand, carbuncles, multiple buboes (specially -on the neck), meningitis, hæmorrhages, pleurisy, -pneumonia, diarrhœa, gastric irritation, cyanosis, -<span class="pb" id="Page_24">24</span> -jaundice and continued pyrexia are unfavourable -signs.</p> -<h2 id="c14"><span class="small"><i>MICROSCOPIC AND MACROSCOPIC APPEARANCES.</i></span></h2> -<p>Bacilli are found in all the internal organs, -notably in the spleen, in blood and in the enlarged -glands.</p> -<p>Body does not show much emaciation; decomposition -commences early. Black hæmorrhagic -patches are often found on the skin. The brain and -membranes are congested. Sanguinous or serous -effusions are found in serous cavities. Right side of -the heart is dilated and is usually found full of -coagulated or liquid blood. Cardiac muscles pale. -The liver is enlarged and congested. The spleen is -much enlarged, soft and congested. Hæmorrhagic -patches have been found in the stomach. The -mesenteric glands are enlarged. Kidneys congested. -Bladder is sometimes found filled with bloody -urine. The buboes are sometimes found to be soft -and caseous. The tissues surrounding them are infiltrated -with a reddish gelatinous exudation. The -whole lymphatic chain from groin to the glands of -the sacral or lumbar plexus, or from the axilla and -neck to the glands of the mediastinum are affected. -The internal glands are found more or less enlarged, -injected and infiltrated with sanguineous fluid. The -lymphatic follicles and Peyer’s patches in the intestines -are found swollen. Hæmorrhages are found -in the mesentery.</p> -<h2 id="c15"><span class="small"><i>PREVENTION.</i>—</span></h2> -<p>It is evident from what has been said that to -prevent plague our efforts should be directed in -<span class="pb" id="Page_25">25</span> -two ways:—(1) To prevent the importation of -germs; (2) to make the environment of a place -such that the germs, even if imported, may not find -suitable condition for their growth. To accomplish -the first we need (<i>a</i>) inspection of people coming -from infected places; (<i>b</i>) stopping importation of -such articles as may carry infection with them; (<i>c</i>) -quarantine, a word which owes its origin to the fact -that, daring the epidemic of plague at Milan in -1527, patients when cured were despatched to -lazarettos and detained there 40 days.</p> -<p>For the second, we require (<i>a</i>) sanitary precautions -by guardians of public health; (<i>b</i>) observance -of rules of personal hygiene by which good -health can be maintained.</p> -<p>(1). Wherever possible a medical inspection -should be made to prevent importation of the disease. -This is, however, a very difficult matter, and one -unforeseen difficulty was experienced at Sukkur, -where it was found that people booked to stations -short of Sukkur, and rebooked at stations on the -other side. Still this measure is highly important, -and should be carried out most rigorously as long as -there is any chance of importation of plague into an -unaffected country. It is needless to feel the pulse -of the patient; his gait, temperature, and look would -afford a great deal of information. Information -should be obtained from where the patient is -travelling. An examination should also be made of -clothes. Dirty clothes, soiled linen and rags should -not be allowed to pass through an inspection post.</p> -<p>(2). There should be a disinfecting or sterilizing -room fitted with a steam sterilizer in all -<span class="pb" id="Page_26">26</span> -large railway stations, where all goods should be -disinfected. Mail bags should also be subjected to -this disinfection. Transmission of such goods as -corpses, used clothes, rags, waste paper, fur, hide, -feather, and fish should be entirely suspended.</p> -<p>(3). If quarantine is imposed, it should be for -a period not less than ten days. Every arrangement, -however, should be made for suitable accommodation -and sanitation in quarantine camps. In a -quarantine camp new arrivals should not be mixed -up with those who are already in quarantine.</p> -<p>(4). Ships from infected ports should be carefully -watched. If any infection is discovered, then -isolation of the sick, disinfection of the ship and -quarantine are required, but ships with clean bills of -health, and if ten days have passed since its departure -from the infected port, may be admitted after -medical inspection. It must, however, be borne in -mind that rats could easily carry infection from one -port to another without any fear of detection. -These facts show that medical inspection and quarantine -may be useful, but they can never be perfect, -and therefore the principal safeguard of a place -lies in the improvement of its sanitation, and therefore -greater attention and energy should be directed -towards it.</p> -<h3 id="c16"><i>Sanitary Measures that should be taken by Municipal and Railway authorities.</i></h3> -<p>(1). All filth should be removed from the -vicinity of towns and villages and <i>burnt</i>, and no -filth of any kind should be allowed to remain within -an inhabited area for any length of time.</p> -<div class="pb" id="Page_27">27</div> -<p>(2). All private and public latrines and public -urinals should be cleaned and disinfected daily. All -receptacles used for night-soil either in the latrine -or for transport should be daily disinfected.</p> -<p>(3). Latrine accommodation, according to the -requirements of the population, should be provided.</p> -<p>(4). Drains should be well washed and -flushed with a disinfectant solution. In towns -where there is an underground sewer, it should be -well flushed and ventilated, and a disinfectant solution -used for cleaning it. A house-to-house examination -should be made to ascertain that all house-connections -are properly and efficiently trapped. -Deposits in the sewer should be taken out and -suitably disposed off after disinfection.</p> -<p>(5). Special attention for cleansing should -be given to the following:—</p> -<p>Cesspools, privies, cow-houses, stables, slaughterhouses, -markets, workshops, common lodging houses, -serais, bustees, and crowded quarters of a town.</p> -<p>(6). All public roads should in the dry season -be watered with a weak disinfectant solution.</p> -<p>(7). Pure drinking water should be supplied. -All articles of food should be inspected. Musty -and decomposing grains should not be allowed to be -sold. The meat market, dairies and bakeries should -be under strict sanitary supervision.</p> -<p>(8). Over-crowding in houses should be prevented. -Steps should be taken for spreading out -the population of much over-crowded and congested -parts of towns.</p> -<p>(9). Lime in a dry state and in solution should -be abundantly used in drains, &c.</p> -<div class="pb" id="Page_28">28</div> -<p>(10). All railway carriages travelling through -infected areas should be daily washed with a -reliable disinfectant solution, such as 5 per cent. -carbolic acid.</p> -<p>(11). Railway platforms, waiting rooms and -halls, and latrines should be frequently cleaned and -disinfected.</p> -<p>(12). There should be a system of house-to-house -inspection to ascertain the sanitary condition -of dwelling-houses, and also to find out, as far as -possible, the condition of health of the inmates.</p> -<p>Common lodging houses, serais and houses of -a similar nature should be most carefully examined.</p> -<p>(13). If plague breaks out, then isolation of -cases is a great necessity. When practicable, such -isolation may be done in the house of the patient. -The patient should be kept in a separate room apart -from those where other inmates of the house live. -A temporary room could be put up on the roof of a -house or in the compound, if there is any, or a tent -may be pitched. Where possible, all healthy inmates -of the house should at once remove themselves -in camp leaving only such near relatives who -must attend and nurse the patient. For patients -living in lodging houses, or, where there is no means -of such isolation as stated above, segregation in -special isolation hospitals should at once be done. -The isolation hospitals should be separate for each -of the following classes—(<i>a</i>) for lower class people; -(<i>b</i>) for middle class people; (<i>c</i>) for such people -of the middle or upper class who may chose to pay -for their expenses. It is needless to say that there -should be special hospitals for women, where only -<span class="pb" id="Page_29">29</span> -female attendants and nurses should be employed. -Hospitals should be provided with means for free -ventilation, both for the sake of patients as well as -attendants. No other disease requires more careful -nursing than the plague, therefore ample nursing -staff should be provided. The hospitals should -have a separate observation ward and a separate -convalescent ward, and by no means doubtful cases -should be mixed up with confirmed cases. Disinfecting -apparatus, sterilizers, good water supply and -special laundry are other adjuncts essentially necessary -for a plague hospital. Greatest care is required -in the management of such a hospital, and only -trained men should be employed.</p> -<p>Suitable means for ambulance should be provided, -and should be had ready within convenient -distances. They should be thoroughly disinfected -after the conveyance of any case. Ambulance carts -or doolies should be comfortable, for physical exertion -and exhaustion, attending a long journey in the -early stage, greatly compromise chance of recovery.</p> -<p>Burial within inhabited areas of a town -or village should be stopped. Dead bodies should -be removed under strict precautions for disinfection -and disposed off quickly. Bodies should be -buried deeply—4 to 6 feet.</p> -<h2 id="c17"><span class="small"><i>PRIVATE HYGIENE.</i></span></h2> -<p>I. Houses and compounds, stables, kitchen and -outhouses should be thoroughly cleaned, and they -should be whitewashed with lime. Air-tight dustbins -should be kept in the house.</p> -<p>II. Rooms, specially bed-rooms, should be well -ventilated, attention should be paid to the condition -<span class="pb" id="Page_30">30</span> -of the floor, which should not be damp, and care -should be taken that rats may not infest the house -and spaces under the floor. If dead rats are found -in the house, they should be removed and burnt, and -the place thoroughly disinfected.</p> -<p>III. House drains should be cleaned and well -flushed with a disinfectant solution.</p> -<p>IV. Nowhere in the house or compound should -any kind of organic refuse be allowed to accumulate. -Better not use any organic manure in the -kitchen garden or house garden during an epidemic.</p> -<p>V. Articles of food should not be allowed to -remain uncovered on the table or elsewhere, for -there is chance of their infection by flies, mice, or -rats.</p> -<p>VI. Clothes received from the dhoby’s house -should be again boiled in water, dried, and then -used.</p> -<p>VII. Bed-clothes and wearing apparel should -be aired and exposed to the sun daily. As frequently -as possible floors and passages should be -well washed with a disinfectant solution and then -well dried.</p> -<p>VIII. There should not be any over-crowding -in bed-rooms.</p> -<p>IX. Drinking water should be boiled before -use. Raw vegetables, such as salad, cucumber, &c., -should only be used after thoroughly washing them, -and then with vinegar.</p> -<p>X. Personal cleanliness should be strictly observed. -Daily bath, cleaning the teeth with carbolic -tooth powder, and carefully washing hands -and mouth before and after meals are essential.</p> -<div class="pb" id="Page_31">31</div> -<p>XI. Those who have to attend on plague cases -should be very careful. Hands should be thoroughly -washed with a disinfectant solution, and a nail -brush used soon after the patient or anything in -contact with him is touched. A bath to which some -antiseptic is added should be taken immediately after -coming in contact with plague patients. Workers -in plague hospitals should be warned about -scratches or wounds on their bodies. Use of respirators -with an antiseptic sprinkled over the entrance -valves is recommended. Only very healthy -people should approach plague cases. On the -appearance of slightest headache, languor, or fever -an attendant should be relieved from duty.</p> -<p>XII. As a prophylactic 5 grains of quinine sulphate -may be taken twice daily, or a small bottle -containing eucalyptus or some other volatile disinfectant, -may be carried in the pocket, and a few -drops may be occasionally poured on the handkerchief. -Smoking good tobacco may have a -prophylactic value.</p> -<p>XIII. If plague occurs in the house, the -following steps should be taken:—</p> -<p>(<i>a</i>) The patient should at once be put in bed -and kept in a temporary room, which may be put up -on the roof of a house. No healthy inmate of the -house should go in that room or have any connection -with the sick, except those who have to nurse the -patient.</p> -<p>(<i>b</i>) All discharges, fæces, urine, sputum, -vomited matter, &c., should be taken in vessels -with disinfectant solution in it, and some quicklime -should immediately be sprinkled over them. On no -<span class="pb" id="Page_32">32</span> -account should anything leave the room but to be -disinfected.</p> -<p>(<i>c</i>) Floor and bedsteads should be washed with -a disinfectant solution, clothes and other articles that -touch the patient should be carefully disinfected. -Crockery and glass should be scalded. If great -care and cleanliness are not observed with regard -to the bed and body linen of the patient, the infection -may be diffused through the air immediately -around the patient.</p> -<p>(<i>d</i>) A medical man should be at once sent for. -Delay is fatal.</p> -<h2 id="c18"><span class="small"><i>INOCULATION AGAINST PLAGUE.</i></span></h2> -<p>M. Haffkine, of cholera inoculation fame, -has commenced to inoculate against the plague -under the same principles on which his inoculation -against cholera is based. By injecting into the -body an attenuated virus of plague, a very mild -attack is produced, which in people inoculated has -proved harmless. This mild attack, it is thought, -would protect the system from more potent forms -of the poisonous germs. The inoculation for plague -is still in its experimental stage, and cannot, for -obvious reasons, be applied to a large population. -Medical attendants, nurses and others who, by call -of duty, have to constantly come in contact with -plague patients may, however, take advantage of this -means of protection, which, in the hands of M. -Haffkine, may yield good results. Yersin also -claims for his serum prophylactic value. In this and -all other matters connected with bacteriology, such -as germs, sero-therapeutics, &c., the medical profession -now-a-days receives a good deal of satirical remarks -<span class="pb" id="Page_33">33</span> -from sceptical lay public. It is natural that it -should be so, for the science of bacteriology is still -in its infancy, and many of its practical applications -are still in their experimental stage. But undoubtedly -the science is advancing, and by its aid we are -now better able to understand diseases and their -nature. Many facts have been demonstrated and -proved with precision. What is disbelieved to-day, -may, however, be believed tomorrow, for, with all -human attempt to reveal secrets of nature, such is the -case. Readers of Smollet’s Roderick Random may -remember how in the Surgeon’s Hall one of the examiners -said:—“I affirm that all wounds of the -intestine whether great or small are mortal.” Now, -however, if a man dies of a wound of the intestine, -the unfortunate doctor in whose hand such a casualty -takes place runs great risk of being charged with -malpraxès.</p> -<h2 id="c19"><span class="small"><i>TREATMENT.</i></span></h2> -<p>I. <i>Hygienic.</i>—The patient should take to bed -immediately on the appearance of the first symptoms. -The room should have means for free ventilation, -and the temperature in it should be between 60° to -70° F. The air of the room may be cooled by -a block of ice. The room should be kept clean, and -there must not be in it any curtain, carpet or hangings. -The floor and bedsteads should be daily washed -with a disinfectant solution. A position of absolute -rest in bed is to be maintained throughout the illness.</p> -<p>Bedpan and urinal should be always used. Bedclothes -should be light and warm. Wearing apparel -if saturated with perspiration should be changed. -It is best to have two beds side by side so as to be -<span class="pb" id="Page_34">34</span> -able to move the patient easily from one to another -for cleansing purposes. Mattresses should be suitably -protected from penetration by the discharges. The -air of the sickroom can be made antiseptic by placing -pieces of blotting paper saturated with eucalyptus -oil or phenol on plates about the apartment or -by pouring carbolic acid on hot water in a plate. -The doorways should be curtained by a sheet wet -with disinfectant solution. Great cleanliness of the -body of the patient should be enforced by cold -sponging with an antiseptic solution. Skilful nursing -is essentially necessary. The motions should be -disinfected by strong antiseptics such as quicklime, -carbolic acid, &c., as soon as they are passed.</p> -<p>II. <i>Dietetic.</i>—From the commencement of the -disease the diet should be liquid and nourishing. -Milk is best. The quantity for adults should not -be less than three or four pints in the twenty-four -hours. It must be given in small quantities at -short intervals. Soda, potash or plain carbonated -water may be mixed with it. Barley water and thin -sago water may also be given. If the patient’s -vital powers are low, the milk may be peptonised -by using Fairchild’s powders or by adding a little -of Benger’s Liquor Pancreatices. In cases when -milk cannot be taken in sufficient amount, animal -food may be given in the form of plain meat broth. -Egg-flip with or without brandy may also be given. -It is useless to give strong meat essences when -the digestive powers are seriously impaired, and -excess of zeal in this direction does a great deal of -harm. These accumulate in the intestinal canal -and form a fermenting mixture in which poisonous -<span class="pb" id="Page_35">35</span> -ptomaines form. Throughout the attack the patient’s -strength should be husbanded as carefully as -possible. When there is thirst, water, or iced water, -or iced beer or stout, or ice-cream, or fruit <i>sherbat</i> -should be given. During convalescence great care -should be taken of diet, for then the vital powers -are at a very low ebb.</p> -<p>III. <i>External.</i>—In order to lower the temperature -rubbing of the skin with oil from the commencement -of the disease has been recommended, -but this procedure is, I think, of no use. I suggest, -however, that when temperature is high 15 drops -of Creosote may be rubbed near the axilla. During -height of fever, the body may be lightly sponged -all over, twice or thrice a day, with the following -solution:—</p> -<table class="center"> -<tr><td class="l">Thymol </td><td class="l"> </td><td class="l">40 grains.</td></tr> -<tr><td class="l">Spirit Lavendula </td><td class="l"> </td><td class="l">2 oz.</td></tr> -<tr><td class="l">Spirit Vin. rectif. </td><td class="l"> </td><td class="l">3 ”</td></tr> -<tr><td class="l">Acid Acetic dil. </td><td class="l"> </td><td class="l">3 ”</td></tr> -<tr><td class="l">Aquæ Rose </td><td class="l">add </td><td class="l">16 ”</td></tr> -</table> -<p>Mustard plasters to limbs and over the heart -should be given when there are signs of failing -heart and circulation, and over the epigastrium when -there is vomiting or hiccough. Smelling salts and -strong ammonia should be applied to the nostrils for -their restorative action. Blister over the nape of the -neck is useful when cerebral symptoms are present. -Ice caps over the head is very useful and should -be applied continuously. The enlarged glands may -be fomented with hot water or spongio-piline wrung -out of hot antiseptic solution. When they are -much painful, poppy or belladonna may be added -to the water. Belladonna with glycerine should be -applied in the beginning and iodine afterwards. Hot -<span class="pb" id="Page_36">36</span> -corrosive sublimate fomentations are also useful. If -the glands suppurate, they should be opened aseptically -and dressed with antiseptics. Proper drainage -should be provided.</p> -<p>IV. <i>Internal.</i>—Knowing as we do that the -plague is due to the toxic products metabolized by -a pathogenic bacillus, the question comes—would an -antiseptic treatment be of any use? Can we by -any means induce an antiseptic action on the blood, -or have we any drug which can act as antitoxin? -It must be at once stated that no drug that has been -tried yet fulfils the above conditions. The claims -of quinine, however, should be taken into account. -This drug in small repeated doses acts as a general -antiseptic. I would, therefore, advocate its use especially -in the early stages. Plague is a disease in -which collapse sets in early and cardiac asthenia is -a very early complication. There is, therefore, great -urgency for early stimulation. Alcohol may be -given freely, but at the same time it must be remembered -that if the organs of elimination are not -acting properly, alcohol may do harm. For their -stimulant effects whiskey or iced champagne may -be given. Carbonate of ammonia or spirit ammonia -aromatic are held to be very useful stimulants in -plague cases. They may be given in combination -with cinchona, digitalis and ether. A prescription -like the following may be useful:—</p> -<table class="center"> -<tr><td class="l">Ammonia Carb. </td><td class="l">5 grains.</td></tr> -<tr><td class="l">Chloric Ether </td><td class="l">20 minims.</td></tr> -<tr><td class="l">Sulphuric Ether </td><td class="l">15 ”</td></tr> -<tr><td class="l">Tint. Digitalis </td><td class="l">5 ”</td></tr> -<tr><td class="l">Tint. Cinchona </td><td class="l">1 dram.</td></tr> -<tr><td class="l">Aquæ Camphor </td><td class="l">1 ounce.</td></tr> -<tr><td class="l"><span class="hst">Every three hours.</span></td></tr> -</table> -<div class="pb" id="Page_37">37</div> -<p>For cardiac asthenia, the following may be tried:—(1) -Caffeine, hypodermically, 5-grains dissolved -by the aid of 5 grains of Sodium Benzoate in 20 -minims of warm distilled water and injected three -or four times a day if needful; (2) Ether or -ethereal solution of camphor hypodermically; (3) -Strychnine, hypodermically, beginning with gr. 1/60 -every four or six hours till gr. 1/16 is injected, or -Liquor Strychnia in 5—10-minim doses every four -hours; (3) Musk may be given in 5-grain doses, or -as in the following mixture:—</p> -<table class="center"> -<tr><td class="l">Pulv. Moschi </td><td class="l">10 grains.</td></tr> -<tr><td class="l">Mucilage Acacia </td><td class="l">2 drams.</td></tr> -<tr><td class="l">Syr. Aurantii </td><td class="l">2 ”</td></tr> -<tr><td class="l">Aquæ Camphor </td><td class="l">½ ounce.</td></tr> -<tr><td class="l"><span class="hst">To be given every 6 hours.</span></td></tr> -</table> -<p>Digitalis does not always give good results, a -fact which Lowson attributes to some inflammatory -or fatty degenerative changes in the small vessels -giving rise to a tendency to hæmorrhage. Stropanthus -may be substituted. Transfusion of blood a -hot saline solution and inhalation of oxygen have -been recommended for collapse. Dr. Viegas of -Bombay recommends Liquor Hydrasgyie Perchloride -10 to 15 minims every four hours if there is no -albumen in the urine. Dr. Dimmock has advised -subcutaneous injection of Guaicol 10 or 15 minims -every two hours. Permanganate of Potash 5 to 12 -grains in 24 hours has also been recommended. -Dr. Blaney has recommended Medritina in two-dram -doses every two hours when the kidneys are -involved. Camphor has been recommended by -some as a cardiac stimulant.</p> -<div class="pb" id="Page_38">38</div> -<h2 id="c20"><span class="small"><i>TREATMENT OF SYMPTOMS.</i></span></h2> -<p>(1). High temperature may be reduced by -antipyretics, such as antipyrin, phenacetin, antifebrine, -&c. These drugs produce profuse perspiration -and a certain amount of depression; it is, -therefore, advisable to restrict their use during the -first few hours only, and if not found responding, -they should be dropped altogether. Pyrexia is but -a sign of the intensity of the activities of the infective -agent, and by artificially reducing the body -heat we really do not lessen the virulence of the -poison, as shown by the rise of the temperature -again as soon as the action of the antipyretic subsides. -Hyperpyrexia itself is, however, an injurious -symptom, and when there is long continued high -temperature it is necessary to reduce it, either by an -antipyretic, quinine or cold bath, or cold sponging. -Cold bath is not suitable in plague patients on account -of the movement of the body which it entails, -and also on account of the serious cardiac depression -which accompanies the disease. Two grains of phenacetin -with 1 grain of hydrobromate of quinine is -a safe antipyretic. Brandy and tepid sponging are -also very useful.</p> -<p>(2). <i>Brain symptoms.</i>—For headache a mustard -plaster behind the upper part of the neck and -over the occiput. Ice cap or Lieter’s tube or plain -water should be applied over the temples and scalp. -Nervine sedatives, such as Potassium Bromide, may -be given for insomnia when there is not much depression. -Otherwise full doses of alcohol may be -tried. Opium should not be used, but in mild cases, -without great depression, 10 to 20 minims of Liquor -<span class="pb" id="Page_39">39</span> -Opii sedativus with 30 minims of Sal Volatile in an -ounce of camphor water may be given to soothe -nervous unrest. For insomnia Lowson speaks -highly of Morpinæ gr. 1/8 to gr. ½. Hyoscine gr. -1/200 to gr. 1/75 may be tried. Meningites should be -treated by cold to the scalp and counter-irritation -to the nape of the neck and occiput.</p> -<p>(3). <i>Hæmorrhages</i> may be treated by Ergot -or Ergotin internally or hypodermically. When -there is much hæmorrhage, use of alcohol should -be partly suspended.</p> -<p>(4). If there is constipation, a dose of calomel -may be given. In the beginning there is almost -always constipation, which should be removed by a -dose of calomel followed by a saline. Diarrhœa -may be checked by an enema of opium. Two grains -of Dover’s powder and 10 grains of tannin mixed -with an ounce of gum mucilage and with two or -three ounces of warm water, arrowroot or starch -may be used for injection. Salol in 10-grain -doses every 4 hours may be given for diarrhœa. -For vomiting and hiccough sinapism over the -epigastrium, sucking of ice, and for thirst acidulated -water with syrup of lemon are recommended. Coma -must be promptly met by cold effusion if there is -pyrexia or by rectal injection of strong coffee. -The bladder of the patient should be carefully -watched. Pneumonia and other complications should -be treated under general principles.</p> -<p>When temperature falls and convalescence begins, -the stimulants should be lessened, and afterwards -a tonic with quinine, acid nitromuriatic dil., -<span class="pb" id="Page_40">40</span> -tincture calumba or quassia may be given with -infusion aurantii.</p> -<p><i>Serum treatment.</i>—The whole system of serum -therapeutics is due to the genius of Pasteur. Diphtheria -and tetanus are diseases that are caused by -specific germs and are now successfully treated by -immunised serum. Tetanus can be prevented and -even cured by the injection of serum of other animals -vaccinated against this disease: this process -has been applied by Yersin for producing a plague -serum, for which a prophylactic and curative power -is claimed, and this serum may be called plague antitoxin. -Yersin treated his first case in Canton. At -Amoy, the people were less averse to treatment, -and in 10 days he was able to treat 23 with two -deaths only. As yet Yersin’s serum has been tried -in the declared diseases, but Yersin also proposes -to use it as a preventive. Haffkine also proposes -to make use of his serum for curative purpose. -Yersin’s serum is older than Haffkine’s, otherwise -bacteriologically they are identical. The subject -is in far too unsettled a condition at present, but -it has no doubt a hopeful future before it.</p> -<h2 id="c21"><span class="small"><i>DISINFECTION.</i></span></h2> -<p>Substances which can prevent infectious diseases -from spreading by destroying their specific -germs are called disinfectants. These disinfectants -can kill pathogenic germs. Heat is a most powerful -agent in killing-germs, therefore anything which is -subjected to prolonged boiling becomes sterile or -germ-free. For purification of clothes and bedding, -heat is the best agent, either by boiling them in -water or by placing them in a hot-air chamber. The -<span class="pb" id="Page_41">41</span> -usual arrangement is a furnace with the smoke -shaft passing under or on one side of a brick chamber -and with a hot-air blast from a shaft running through -or under the fire into the chamber itself, or into a -passage below it, whence it passes into the chamber -through a valve; an exit for the hot-air is provided -at the top of the chamber, the clothes are suspended -in the chamber, at a little distance from the walls. -Various kinds of ingenious apparatus have been -recently contrived and are used. Steam disinfecting -chambers are necessary for the disinfection of -clothes, &c., of a large population, and all large -towns and railway stations should have them. High -pressure steam in an apparatus contrived for the intermission -of its pressure is found to give the best -heat penetration to large non-conducting articles -such as bedding. Fumigation by burning sulphur -or chlorine is a very useful method for disinfection -of rooms. Large bonfires of sulphur may also -have a beneficial effect on the air.</p> -<h2 id="c22"><span class="small"><i>PURIFICATION OF A ROOM AFTER PLAGUE CASES</i>—</span></h2> -<p>All woodwork should be thoroughly cleansed -with soft soap and water, to which a little carbolic -acid has been added. The walls should be scraped -and then washed with hot lime to which carbolic -acid should be added in the proportion of one pint -to four gallons of water. Then the room should -be fumigated for 3 hours, with all doors and windows -and the chimney being closed, sulphur about 1 -seer for every 100 cubic feet of space should be -put in a metallic dish, a little alcohol is poured on -it, and it is lighted. After 3 hours the doors and -<span class="pb" id="Page_42">42</span> -windows should be opened and kept open for 24 or -36 hours. Rooms may be disinfected by chlorine. -Carbolic acid in 5 per cent. solution is useful for -all ordinary purposes, such as washing hands, -utensils, &c.</p> -<p>Quicklime is the cheapest and the most easily -procurable disinfectant for drains and for disinfection -of discharges. Carbolic powder made by adding -carbolic acid to lime is very useful for the -disinfection of public latrines, drains and sewers. -Corrosive sublimate, in the proportion of 1 part -in 4,000, is the most efficient germicide known -and should be used diluted with water for sprinkling -on public roads and for flushing drains and -washing latrines, &c. It is, however, poisonous and -corrodes metal drain pipes. In quarantine or isolation -camp the latrines should be of the dry earth -system. Carbolic acid powder should be largely -used in them. The question of suitable disposal of -sewage depends on the circumstances of each town -or village, but incineration is the most sanitary -method during an epidemic. Other disinfectants -too, such as Jey’s Fluid, Creoline, Phenyle, Izal, -Sanitas, may also be used.</p> -<h2>Transcriber’s Notes</h2> -<ul> -<li>Silently corrected a few typos.</li> -<li>Retained publication information from the printed edition: this eBook is public-domain in the country of publication.</li> -<li>In the text versions only, text in italics is delimited by _underscores_.</li> -</ul> - - - - - - - -<pre> - - - - - -End of the Project Gutenberg EBook of The Bubonic Plague, by A. 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