Sessional_Paper_1895 — Page 201

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Vomiting was often one of the first symptoms that required treatment and this was usually stopped by an efficient mustard plaster on the epigastrium. Vomiting and diarrhoea rarely went together and the best treatment for the former was to procure satisfactory purgation by calomel. I can only remember one or two cases where vomiting was persistent and obstinate after this treatment. If the above means were not sufficient, ice to suck and some hydrocyanic acid and liq, morphiæ in an effervescing mixture, given occasionally, generally sufficed to check it. A mustard plaster was also a most efficient application to the epigastrium.

In mild cases small doses of quinine gr. iii thrice a day were sometimes sufficient, with adequate nourishment. Before speaking further of treatment the following axiom must be enunciated-never use depressants if you can possibly do without them. The great tendency to cardiac failure has often been noticed in Bubonic Plague, but I do not suppose its more frequent occurrence due to the introduction of Western medicine has been notel. I'must confess that many cases were not benefitted by some of the drugs used--drugs which are so often given with impunity in other serious diseases-and in making this statement I am criticising my own as well as my colleagues' treatment. The reason why we did not find out this alnost at the beginning of the outbreak was that we had no time to watch the immediate effect of our treatment as there was so much to do, and in many cases which we had marked to watch carefully the patient had succumbel before the next visit was paid.

It has to be borne in mind that we had great difficulties to contend with as regards exact and proper clinical observation at the outbreak of the visitation, there being so many duties to perform-apart from Hospital work—that our medical staff was quite unequal to the strain thrown upon it.

Reduction of temperature was always attempted by tepid sponging, and even then ice had to be freely used as the temperature of the water we had to use was always over 73° F. and generally over 80° F. Patients with a temperature of 104° F. and over were sponged every hour through the day or as nearly every hour as circumstances would permit. All patients with a high temperature were benefitted by cold applied externally, and this sponging was always the best antipyretic. Antipyrin in large doses was frequently followed by disastrous results, and towards the end of the epidemic grs. v. of phenacetin were given when the pulse was fairly good, phenacetin evidently being less depressing than antipyrin. Not only this but even by the use of large doses of antipyrin or phenacetin tempo- rature was only very occasionally re laced by more than 2° F.; a result hot commensurate with the danger run. Brandy and tepid sponging were without doubt the best antipyretics. Aconite and antimony were tried once or twice to commence with; the idea being that by keeping the circulation quiet for 24-48 hours and then stimulating, the patient might have a better chance of pulling through. This treatment was a failure.

The question of procuring sleep was an important one and here nor hia was our sheet anchor all through the epidemic. Notwithstanding the fact that in plague we have almost all the contra-indications for the use of morphia yet it was far and away the most serviceable drug. In the early stages of the disease it was often given freely; and in the later stages, used in much smaller doses, it was of equal benefit. Granting its apparent danger, it proved in result much more satisfactory than any other hypnotic use. From one eighth to one half a grain at night was given as a rule with safety at the commencement of sickness, while in later stages gr., re peated if required, was the general dose. Notwithstanding all this I admit that it is necessary to carefully judge what cases to give it in, and when to give it; and to remember that grave issues must be faced in giving it.

Hyoscin in doses of from 1/200 gr.-1/75 gr. was the next best hypnotic we used. In some cases it acted in a marvellous way, in others it was apparently without effect. Chloral and bromide of potash in combination (the usul doses of grs. xx and grs. xxx respectively) was in many instances quite sufficient, but here the cases were as a rule mild. The ice-bag should be in continuous use. Case our hospital "boy"-was conscious at intervals almost to the last, and the only thing he resented was the removal of the ice-bags when they had to be refilled. The ice bags should be large and one should be placed on the forehead and the other at the nape of the neck.

Blistering of the nape of the neck and lower occipital region was sometimes beneficial. We found the best way to do this was to use the emplastrum lyttæ as Dr. HORDER suggested, viz., by repeated but short applications just to prevent vesication. Of Leiter's tubes we had none, and the imitations we got made by Chinese workmen were not a success consequently they were not tried.

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