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To imagine that suppuration is a good sign is to put the cart before the horse, the suppuration coming after the recovery from the acute stage of the disease.
I liked to see a patient with three or four copious loose motions per diem, not amounting to diarrhoea. As a rule this was often the patient who was not troubled with vomiting, and whose brain symptoms were not so severe.
In this as in other diseases a good heart, physically and morally, is the best thing a patient can possess.
TREATMENT.
Hospital Prophylaxis. —At the beginning of the epidemic every precaution that we could think of was taken to prevent the infection of attendants. Most of these precautions were useful and necessary, whilst others proved to be more in the nature of luxuries. As our knowledge and experience of the disease progressed we were able to bring down our requirements to fine lines. Plenty of fresh air was a sine qua non, botli for patients and attendants. At first attendants were allowed to smoke as they pleased, and as a couple of rabbits died in two days, after inoculation by blood from our first case, nurses had strict orders to be careful of all wounds or scratches on their fingers, and to see that they were dressed with some antiseptic at once. They were ordered to use eucalyptus oil or carbolic acid solution on their hand- kerchiefs, more especially when the hospitals were crowded, but when a more plenti- ful supply of fresh air was forthcoming this was left off. Fæces were disinfected by quickline or carbolic acid, as were all dressings.. At the Slaughter House Hospital Jeyes' fluid was used as the disinfectant all along. If at any time the wards smelt badly from any cause, or the stillness and closeness of the atmosphere became oppressive, some eucalyptus oil evaporated over small lamps had a wonderful effect in alleviating the nauseated feeling that sometimes came over the attendants. In the beginning nausea was sometimes brought on by the cigars or pipes which were freely used, but as we gained experience this was all remedied.
All patients' clothes, being practically worthless, were burned on admission. Patients were given a hot bath, if in a condition to stand it; or were sponged down on the bed. Chinese who were not wildly delitions were placed on the ordinary Chinese bed and mat; but if likely to do themselves harm they were put on a mattress. Mattresses, pillows and inats were burned after being in use some time, the length of time in use depending on the amount of soiling. If we had had a more ample supply of mackintosh sheeting, a large one would have been put on each bed, as being by far the best way of keeping beds in a sanitary condition. One thing to be beware of is not to give purgative medicine to all new patients at the same time. Often when a number of patients had calomel after the evening rounds the nurses had rather a hard time of it the following morning, which delayed the routine work of the hospitals too much. Carbolic acid and permanganate of potash were of necessity freely used in the wards; blankets and sheets being frequently washed in a solution of the former. With the accommodation at our disposal attendants, when unemployed, were kept as far away from the hospital as possible, and plenty of soap and carbolic acid was supplied to them.
Any attendant, complaining of headache, languor, sore throat or fever was immediately relieved from duty. Only healthy people should be allowed to approach plague cases.
Prophylactic measures should consist in remedying the causes that predispose to the disease. During an epidemic personal cleanliness should be carefully observed by those who have any work to do which takes them near the infected district. In addition to the usual daily tub a bath should be taken immediately after coming out of the affected area, some disinfectant like Jeyes' fluid being used in the water. A change of clothes is essential, and those that are discarded should be removed immediately, and exposed to the fresh air. If it is no trouble they may be put through the steam steriliser, but it will be found that free exposure to air in the sunlight will be suffic'ent. With regard to those who are employed on cleaning or disinfecting houses the following precautions should be observed. Free smoking should be allowed. The workers should be warned about scratches or wounds on their bodies; and a medical inspection of them should be made every day; those with wounds not being permitted to do the dirty part of the work. Preferable to smoking would be the use of respirators with exit and entrance valves; and a sprinkling of thymol or menthol over the entrance valves. Professor KITASATO suggested oil of peppermint. If smoking goes on then a carbolic mouth-wash should also be insisted on. As regards stimulants, these should be dispensed carefully but not too freely, the nauseating character of the work in a dirty town sometimes suggesting a too occasional glass of whiskey or other alcoholic stimulant.
Before
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