Part 5

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.