Part 4

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.