( 22 )
VI-TREATMENT.
( 23 )
191
The treatment of plague has hitherto been prophylactic and symptomatic merely.
The first care was to isolate the patient and to place him in a well-ventilated and airy room. The clothing the patient wore when he was brought into hospital was burned. Care was taken to disinfect thoroughly the stools, the urine, and the expectoration of the patient, as well as the bed linen, and other articles used by him in hospital. Those that recovered were provided with entirely new clothing when they left the hospital.
In the symptomatic treatment, the first endeavour was to sustain the power of the heart by large doses of alcohol, by preparations of ammonia, or by subcutaneous injections of ether and camphor. When the fever rose too high, above 39.5° C. (103° F.), cold baths, ice, phenacetin, antipyrin, and quinine were employed. In Chinese patients, who were not accustomed to cold baths in daily life, their use caused such profound collapse that they were soon abandoned. Of the medicines employed to lower the temperature, the most useful was phenacetin, for it produced no unpleasant secondary symptoms, and in doses of 0.5 to 1.0 gram (8 to 16 grains) almost always reduced the temperature to the normal for from six to ten hours. Antipyrin was much less suitable for the purpose, on account of its depressing influence on the heart. Quinine, in daily doses of 0.5 to 1.0 gram (8 to 16 grains) proved useful in the secondary fevers arising in the later course of the disease.
As long as the fever lasted, fluid nutriment only was given, such as milk, rice-water, beef-tea, chicken-broth, and eggs. After the cessation of the fever, a change was gradually made to solid food. As a drink, good cold tap-water of undoubted purity was given, or seltzer water, with or without brandy.
Bronchial catarrh was treated with expectorants.
VII. THE ORIGIN AND THE MODE OF DISSEMINATION
OF THE PLAGUE AT HONGKONG.
That we may be able to understand the origin and the mode of dissemination of the plague at Hongkong, it will first be necessary to describe shortly the fundamental peculiarities of Hongkong, the town of Victoria, of the dwellings, and of the inhabitants.
00
The English Colony of Hongkong consists of the island of Hongkong and of the district of Kowloon on the adjacent mainland, the two being separated by a channel from 2 to 4 km (1¼ to 2½ miles) wide. Hongkong is 142 km (89 miles) south-east of Canton, and 62 km (39 miles) east of Macao. It is about 15 miles long and from two to five miles wide. It is mountainous, and consists of granite rock. The climate is tropical. The hot season lasts from the middle of April to the middle of November, and the cool season from the middle of November to the middle of April. The weather is changeable. The heaviest rains fall in April, May, June, July, and August.
The town of Victoria, built in the European style, lies on the north side of the island, facing the mainland; and extends from east to west between the hills and the sea, stretching up the hill-side. The low-lying parts of the town, especially the west and centre, contain, in addition to barracks, factories, shops, and the dwellings of Europeans, everywhere the dwellings of Chinese; whilst on the tops of the hills and on the hill-sides are found the dwellings of Europeans only.
The low-lying parts of the town are traversed from east to west by several parallel main streets, with plaster-fronted houses. These main streets are intersected by numerous narrow by-streets. The houses in the upper part of the town are built in a detached manner, and receive from all sides plenty of light and air; but this is not everywhere the case in the lower parts of the town, especially in the narrow streets of the Chinese quarter.
On the island, there are other districts, inhabited chiefly by Chinese, named Shau-ki-wan, Aberdeen, and Stanley.
In severe disturbance of the sensorium and in violent delirium, an ice-bag was placed on the head, and narcotics were given.
In unconscious patients, the bladder was in many cases emptied at stated intervals.
To clear out the bowels, calomel was given in large doses of 1.0 to 2.0 grammes (15 to 30 grains) daily, or castor oil was given or enemata were used. In severe and exhausting diarrhoea, Dover's powder, bismuth and opium, or tincture of opium was used.
When the lips and mouth became very dry, they were cleansed and moistened with a damp linen rag. Dry or fissured lips were smeared with vaseline.
The glandular swellings were rubbed with various kinds of ointment, painted with tincture of iodine, or treated with wet compresses or with poultices. Glandular and other abscesses were opened, cleansed, and treated with iodoform, etc.
In June and July, 1896, in Canton and Amoy, YERSIN, by the subcutaneous injection of an anti-toxic serum, prepared partly in the Pasteur Institute in Paris and partly by himself in Saigon and derived from immunised horses, is reported to have completely cured in a few days 15 out of 21 patients. According to the account given to me in Hongkong by YERSIN himself, the action of the serum was an extremely rapid one, so that in one or two days after the injection the fever and the buboes had entirely disappeared, and the patients had recovered with remarkable rapidity. The result of the serum injections is most favourable when they are made immediately after the onset of the disease. In severe cases after the third day from the beginning of the illness, in consequence of the great weakness of the heart and the too intense poisoning of the system by the products of the life activity of the bacillus, a successful result is hardly to be expected.
The quantity of serum injected was considerable, and reached as much as 50 c.c. The method of preparing the serum, which is analogous to that of the anti-toxic serum for diphtheria, was described by YERSIN, CALMETTE, and BORREL in the Annals of the Pasteur Institute for 1895.
* La Peste bubonique, Deuxième Note par M.M. Yersin, Calmette, et Borrel (Travail du laboratoire de M. Roux à l'Institut Pasteur).
The Kowloon district on the mainland, to which the small town of Yan-mua-ti belongs, lies on stony, level ground immediately bordering on the sea. Here also, the streets of the Chinese quarter are for the most part very narrow.
The Chinese inhabitants of Victoria have for some years numbered on the average 173,000; those of Kowloon 25,000; those of Shau-ki-wan about 9,000; those of Aberdeen about 3,000; those of Stanley about 1,000. A large proportion, however, of the above enumerated Chinese population of the Colony of Hongkong, lives on the water, on the so-called sampans or junks in the harbour; of these about 18,000 belong to the town of Victoria, 6,500 to the district of Kowloon, 4,800 to Shau-ki-wan, and 550 to Stanley.
The number of the non-Chinese population of the Colony is about 10,000, of whom one half are Europeans, and the rest Indians, Eurasians, Japanese, etc.
The Chinese population, numbering about 215,000, lives in an area 1/10th, or 1/15th, the size of that inhabited by the 6,000 or so Europeans. In addition to this overcrowding, the Chinese houses in 1894, and still to a large extent in 1896, presented bad hygienic conditions in the shape of deficient access of light and air, imperfect removal of slop-water and excreta, and great uncleanliness of the inhabitants. The houses and their inhabitants must therefore be briefly described.
The houses of the Chinese are built of stone, are usually three storeys in height, have small windows, and these commonly only on the side facing the street. In each storey, there is a dwelling-room, reached in the upper storeys by a steep stair, and a kitchen. In each dwelling-room, several families usually live in separate partitions. The number of persons living in such a room is often sixteen to twenty-five. In 1894, cellars also, to which the light and fresh-air could gain no access, were used as dwellings, but this is now forbidden.
With the excessively filthy habits of the Chinese, the rooms are very rarely cleaned.
Owing to want of space, Chinese houses have no privies. Usually, in the dwelling-room or in the kitchen, there is an earthenware pot used to receive the excreta. Frequently, the Chinese used, and indeed still use, the slop-water pipe leading from the kitchen either...
( 22 )
VI-TREATMENT.
( 23 )
191
The treatment of plague has hitherto been prophylactic and symptomatic merely.
The first care was to isolate the patient and to place him in a well-ventilated and airy rod The clothing the patient wore when he was brought into hospital was burned. Care was taken to disinfect thoroughly the stools, the urine, and the expectoration of the patient, as well as the bed bed-linen, and other articles used by him in hospital. Those that recovered were provided with entirely new clothing when they left the hospital.
In the symptomatic treatment the first endeavour was to sustain the power of the heart by larg doses of alcohol, by preparations of ammonia, or by subcutaneous injections of ether and cample When the fever rose too high, above 39.5° C. (103° F.), cold baths, ice, phenacetin, antipyrin, and quinine were employed. In Chinese patients, who were not accustomed to cold baths in daily life their use caused such profound collapse that they were soon abandoned. Of the medicines employed to lower the temperature, the most useful was phenacetin, for it produced no unpleasant secondary symptoms, and in doses of 0.5 to 1.0 gram. (8 to 16 grains) almost always reduced the temperatur to the normal for from six to ten hours. Antipyrin was much less suitable for the purpose, o account of its depressing influence on the heart. Quinine, in daily doses of 0.5 to 1.0 gram. (S to if grains) proved useful in the secondary fevers arising in the later course of the disease.
As long as the fever lasted, fluid nutriment only was given, such as milk, rice-water, beef-te chicken-broth, and eggs. After the cessation of the fever, a change was gradually made to solid food As a drink, good cold, tap-water of undoubted purity was given, or seltzer water, with or withou brandy.
Bronchial catarrh was treated with expectorants.
VII. THE ORIGIN AND THE MODE OF DISSEMINATION
OF THE PLAGUE AT HONGKONG.
That we may be able to understand the origin and the mode of dissemination of the plague at Hongkong, it will first be necessary to describe shortly the fundamental peculiarities of Hongkong,
the town of Victoria, of the dwellings, and of the inhabitants.
00
The English Colony of Hongkong consists of the island of Hongkong and of the district of Kowloon the adjacent mainland, the two being separated by a channel from 2 to 4 km. (14 to 24 miles) wide. Hongkong is 142 km. (89 miles) south-east of Canton, and 62 km. (39 miles) east of Macao. It is about 15 miles long and from two to five miles wide. It is mountainous, and consists of granite rock. The climate is tropical. The hot season lasts from the middle of April to the middle of November, and the cool season from the middle of November to the middle of April. The weather is changeable. The heaviest rains fall in April, May, June, Jaly and August. The town of Victoria, built in the European style, lies on the north side of the island, thing the mainland; and extends from east to west between the hills and the sea, stretching up the ill-side. The low-lying parts of the town, especially the west and centre, contain, in addition to barracks, factories, shops, and the dwellings of Europeans, everywhere the dwellings of Chinese ; whilst on the tops of the hills and on the hill-sides are found the dwellings of Europeans only.
The low-lying parts of the town are traversed from east to west by several parallel main streets, with plaster-fronted houses. These main streets are intersected by numerous narrow by-streets. The houses in the upper part of the town are built in a detached manner, and recive from all sides plenty of light and air; but this is not every where the case in the lower parts of the town, especially in the narrow streets of the Chinese quarter.
On the island there are other districts, inhabited chiefly by Chinese, named Shau-ki-wan, Aberdeen,
In severe disturbance of the sensorium and in violent delirium, an ice-bag was placed on the head, and Stanley. and in case of need narcotics were given.
In unconscious patients, the bladder was in many cases emptied at stated intervals.
To clear out the bowels, calomel was given in large doses of 1.0 to 2.0 gramines (15 to 30 grains)) daily, or castor oil was given or enemata were used. In severe and exhausting diarrhura, Dover's powder, bismuth and opium, or tincture of opium was used.
When the lips and mouth became very dry, they were cleansed and moistened with a damp linen rag. Dry or fissured lips were smeared with vaseline.
The glandular swellings were rubbed with various kinds of ointment, painted with tincture of iodine, or treated with wet compresses or with poultices. Glandular and other abscesses were opened, cleansed, and treated with iodoform, etc.
In June and July, 1896, in Canton and Amoy, YERSIN, by the subcutaneous injection of an anti- toxic serni, prepared partly in the Pasteur Institute in Paris and partly by himself in Saigon and derived from immunised horses, is reported to have completely cured in a few days 15 outd 21 patients. According to the account given to me in Hongkong by YERSIN himself, the action of the scrum was an extremely rapid one, so that in one or two days after the injection the fever and the bubocs had entirely disappeared, and the patients had recovered with remarkable rapidity. The result of the serum injections is most favourable when they are made immediately after the onset of the disease. In severe cases after the third day from the beginning of the illness, in consequence of the great weakness of the heart and the too intense poisoning of the system by the products of the life activity of the bacillus, a successful result is hardly to be expected.
The quantity of serum injected was considerable, and reached as much as 50 centimetre. The method of preparing the serum, which is analogous to that of the anti-toxic serum for diphtheria, was described by YERSIN, CALMETTE, and BORREL in the Annals of the Pasteur Institute for 1895.*
* La P'e
bubonique, Deuxième Not e par M.M. Yersin, Caluette, et Borrel (Travail du laboratoirs de M. Roux à l'Institut Pastour).
The Kowloon district on the mainland, to which the small town of Yan-mua-ti belongs, lies on Here also, the streets of the Chinese quarter stony, level ground immediately bordering on the sea. are for the most part very narrow.
The Chinese inhabitants of Victoria have for some years numbered on the average 173,000; those of Kowloon 25,000; those of Shau-ki-wan about 9,000; those of Aberdeen about 3,000; those of Stanley about 1,000. A large proportion, however, of the above enumerated Chinese popula- tion of the Colony of Hongkong, lives on the water, on the so-called sampans or junks in the harbour ; of these about 18,000 belong to the town of Victoria, 6,500 to the district of Kowloon, 4,800 to Shau- ki-wan, and 550 to Stanley.
The number of the non-Chinese population of the Colony is about 10,000, of whom one half are Europeans, and the rest Indians, Eurasians, Japanese, etc.
The Chinese population, numbering about 215,000, lives in an area 1/10th, or 1/15th, the size of that inhabited by the 6,000 or so Europeans. In addition to this overcrowding, the Chinese houses in 1894, and still to a large cxteut in 1896, presentel bad hygienic conditions in the shape of deficient access of light and air, imperfect removal of slop-water and excreta, and great uncleanliness of the inhabitants. The houses and their inhabitants must therefore be briefly described. The houses of the Chinese are built of stone, are usually three storeys in height, have small windows, and these commonly only on the side facing the street. In each storey there is a dwelling-room, reached in the upper storeys by a steep stair, and a kitchen. In each dwelling-room several families usually live in separate partitions. The number of persons living in such a room is often sixteen to twenty- five. In 1894, cellars also, to which the light and fresh-air could gain no access, were used as dwellings, but this is now forbidden.
With the excessively filthy habits of the Chinese, the rooms are very rarely cleaned.
Owing to want of space, Chinese houses have no privies. Usually in the dwelling-room or in the dwelling-room or in the kitchen, there is an earthenware pot used to receive the excreta. Frequently the Chinese used, and indeed still use, the slop-water pipe leading from the kitchen either
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