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CLINICAL CASES.
The notes of these cases are necessarily rough. Time to re-write them is unfortunately not at my disposal, but it is to be hoped that they will afford a certain amount of interest to medical men even as they are. The remarks made. on some of them are not lengthy for the simple reason that we have still a good deal to learn on the subject of plague, and many doubtful points suggest them- selves, which it is to be hoped may yet be cleared up. It will be found that some of the treatment does not correspond with what has been advocated in foregoing pages, but it should be remembered that, in dealing with such a fatal disease, it was some time before the best treatment could be definitely laid down; whilst it is probable that even now we have not yet arrived at the best method of dealing with it.
Case I,-Chinese. Et. 25.
This boy was our hospital attendant. He left hospital at 9 p.m. on Sunday, April 29th, and came back at 9 a.m., May 1st. This thirty-six hoars was the only time that he was out of the hospital and did not leave again before he went on the sick list. He complained of feeling unwell on the afternoon of the 5th May, and when his temperature was taken at 6 p.m. it was found to be 103° F. I did not see him until about 1 a.m. on the 8th; be informed me that the swelling of the left femoral gland, which was apparent, first commenced on the evening of the 6th May, but he had not mentioned that to the Medical Officer on duty. The gland was, at this time, the size of a large walnut; there were no lymphatic vessels affected, at least, none were to be seen inflamed; there was no sore on the foot but a small scratch was visible two inches below the knee on the inner side and there were no signs of inflammation or suppuration around it; there were no other glands to be felt enlarge. Great headache. Treatment up to the 8th was quinine grs. x. every three hours and phenacetin grs. x. occasionally, bat during the latter day had aconite m. v. and autimony wine m. viii. every four hours only.
MAY, 1894.
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On the 9th: pulse still fairly good, but although the temperature is better he is in a more stupid condition and very anxious about himself at times; the mouth and throat are very dry; ice-bag applied to nape of neck and top of head. Chlorate of potash gargle ordered for the throat in addition to aconite mixture. 10th very torpid this morning, pulse worse and easily compressible complains greatly of hotness in the throat, passing urine in bed, 3 p.m. had a convulsion. Examina- tion of blood shewed rapid crenation of corpuscles—s
-some of them broken down and particles of pigment in some of the white ones (I believe that some of those when seen stained were bacilli, but I did not recognise them as such). At 7.15 that evening the convulsions became very frequent and he had hyd. of chloral gr. xxx, and brom. of potash gr. XL in two doses. The percentage of homo- globin in the blood 50.
At 2 a.m. on the 11th as the convulsions were still severe, he had brom. grs. XL. and chloral grs. xxx. again. In the morning his mind was clearer and he complained much of his mouth being dry, with sordes on the teeth, &c. Hæmoglobin 35 per cent. There have been no more convulsions since the bromide and chloral in the early morning. All day the conjunctiva have been suffused-
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