Sessional_Paper_1904 — Page 562

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Report on Plague Cases treated in Kennedy Town Hospital.

KENNEDY TOWN HOSPITAL,

HONGKONG, 6th July, 1903.

SIR-I have the honour to report, for the information of His Excellency the Governor, regarding the Plague cases that have been treated in Kennedy Town Hospital this year up to this date.

2. Two hundred and eight-two cases of Plague have been admitted to this date, of which 87 were discharged cured, 171 died, and 24 are still in Hospital, but all convalescent. All these 24 will almost certainly recover completely, and for purposes of my calculations in what follows I shall class them with those cured. As the epidemic seems practically over, future admissions to the Hospital this year will probably scarcely interfere with general statements that may now be made; and this year's figures may, I think, be quite fairly compared tentatively with the total figures for previous years.

3. At the beginning of the epidemic, as fresh curative serum is not yet avail- ble locally, and as last year's experience sufficiently proved serum imported from Europe to be useless, I decided to continue trials I had made to some extent in the two previous epidemics as to the curative value of oil of Cinnamon. As an aromatic volatile oil it is antiseptic, and it is absorbed into the blood unchanged, so I gave it in large doses in the form of the essence, in the hope that it might be absorbed in sufficient quantities to exercise its antiseptic action against the Plague Bacilli, After a further series of 30 cases, however, I abandoned it as useless.

4. The next series of cases, over a hundred in number, I treated on general principles, symptomatically, until the 18th of May, when you suggested to me a further trial of Carbolic Acid in larger doses than when I previously used it in this Hospital.

5. I consented to make such further trial, though, I confess, without much hope of its proving of value. I had in 1901 used this drug in a series of over 200 cases in doses of 80 grains a day, and while the mortality in that year was 76.5%, slightly less than the average, I did not think it had been much affected by the

treatment.

6. It was, I think, your proposal that one should begin with an initial dosage of 14 grains in 24 hours, but rapidly diminish the quantity given. I determined, however, to push the remedy to the utmost, and, while watching carefully against any appearances of poisoning, to give the drug in full doses so long as Plague Bacilli were present in the blood. I accordingly gave 144 grains of Carbolic Acid daily, divided into two-hourly doses of 12 grains each, and administered, as two years ago, in a mixture flavoured with syrup of Orange and Chloroform water, in some cases over long periods.. Inspector KNIGHT, for instance, consumed over 2,500 grains of pure Carbolic Acid before his blood was free from Plague Bacilli.

7. With these enormous doses, I expected evidence of Carbolic Acid poisoning to appear frequently, but it was practically unknown. In a few cases Carboluria developed, but the omission of one or two doses was usually sufficient to clear the urine, and permit resumption of the remedy in full doses. In certain cases dys- peptic symptoms occurred, but in these greater dilution of the mixture with water was all that was required to overcome this obstacle to its consumption,

This absence of untoward symptoms is probably an incidental testimony to the purity of the Apothecary's stock of Carbolic Acid, as Carboluria is believed to be due more to impurities in the acid than to the drug itself.

8. As a result of observation of its use in a series of 143 cases, I consider Carbolic Acid in large doses the most hopeful means of treating Plague thus far at our disposal in Hongkong.

9. Before looking at the actual figures, there are two circumstances that need to be mentioned, and for which due allowance must be made :-

(1) The treatment with Carbolic Acid was commenced late in the epidemic, at a stage when there is a greater natural tendency to recovery, the disease being invariably more virulent early in the season.