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Eminent London Physician Writes Concern-
.Once Secures Foothold Methods
Suggested by Modern Science.
One of tiio moat Important articles of recent publication rclatlvo to
the bubonic plnsuc appears In a recent Issue of Tho Practitioner (Lon
don..) Tho author, Jnmes Cnntlle, M. U-, F. It. C. S., D. I'. H. II. C. P.,
Is lecturer In tho. London School of Tropical Medicine. Ho tlcnls with
the subject In relation to Great Britain's danger from tho appenranco
.of tho plaguo In Oporto. 1 ho following excerpts havo been mado which
have particular value lpcnlly owing to our nearness to tho Orient:
Tho presence ot tho. plaguo In Portu-1
1 I.. .. ..,, ...Moll mnnirlll nil Wll. I
rope, and ono which Is of special lm-1
portanco to i;ngianu. Aitnougu mo
outbreak at Oporto Is frequently term
ed "mild" In typo, that Is no guaranteo
thnt tho disease will disappear any tho
Roooner, nor that a virulent outbreak
may not BUpervcne, either In Oporto or
elsewhcro In Western Kuropc. Tho
pertinacity with which plaguo main
tains Its hold on n community has been
exemplified ngaln and again during tho
past flvo years; and the mildness of
its first encroachment Is no Indication
of Its subsequent bohalor. Hongkong
has had flvo virulent epidemics of
plaguo between tho years 1S9 !-!..
llombay has hail several recrudescen
ces during the last threco years, and
Calcutta affords an cxamplo ot tho ten
acity and chronlclty of plaguo apart
from an epidemic form. In many
towns In India It was finally belloved
that plaguo was successfully stamped
out, but these hope3 and beliefs have,
In every Instance, been shnttered.
Plague resembles no other disease In
Its epidemiology, nnd It Is only by a
close study of Its peculiarities that a
eorrcrct estimation of Its true charac-
VAHlETli:S OF TVl'K.
ter can bo formed. Tho term "bu
bonic" has been fiequently used to
designate truo plague, but buboes aro
by no means nn essential sign of
plague. In many outbreaks but few
cases of a bubonic nature havo been
met with, so fow. In fact, that enlarge
ment of tho glands proves iho excep
tion rather tnan tho rule. Again, a
succession of outbreaks in the samo
city seldom preserves tho samo typo;
pneumonic symptoms prevailing In
ono, buboes In another, and yet, again,
n rnxln nr Rpnrnomli'. fnrm In thp third
accession of tho dlseaso. So numcr- verandah, or into tho street. The ac
ous aro theso divergent forms that tho utm. Is. however, a moro "wandering
varieties of plague aro grouped by sev
eral writers as ollowa
Tho Ilubonlc form. The Pneumonic
variety. Tho lutcstliiul type. Tho
Nervous symptoms, always u featuro
In tno disease, may bo so pronounced
.is to put In c shade all minor evi
dences of tho disease, and Justify tho
group being termed tho Cerebral.
Tho names Toxic and Sldcrans are
conferred upon a rapidly fatal class
of cases In willed tho usual clinical
signs aio absent, and Uie symptoms
indicate n severe form of toxaemia
A Typhus form Implies a resem
blanco between plague nnd mallguant
Testis Ambulans refers ,to u jnlld
form of tho disease.
Pestls minor may precede, run con
currerntly with, or flourish after an
epidemic of true plague In Hongkong,
lit Calcutta, In Alexandria, on tho Vol
ga, and In many other places, sporadic
of even epidemic outbreaks of adenitis
going on to suppuration, disintegra
tion ami death of n gland or group of
glands hnvo been recorded. Whether
theso aro really afllllated with truo
plnguo is .doubtful, but the coincidence
is worthy of note, especially If It bo
proved that Posils minor in a foro mi
ner of plaguo Infection.
An cuumerailon of the various types
is Important, jia tho disease, nt tht pre
sent day has been seen but by lew
practitioners Ju 'Britain, and Hi ap
pearance upon our shores may icrauln
undiagnosed for porno time If but ono
typo, the bubouJc, Is taken as the
evidence of its existence.
Tho danger ot healthy human be
ings becoming infected by persons 111
of plaguo Is remote. That tho human
being can bo Inoculated by nlacuo Is.
Tho channel by which pluguu Is ac
quired may bo either by tho alimentary
canal, by the respiratory tract, or by
tho skin. Wo havo Been that aninmis
given plaguo tissues, or cultures, to cat
suffer from tho disease, and (hero can
bo no doubt that human beingK nro In
fected by food. Tho facses of a rnt or
mouse getting Into human food, or flics
from n dead rat of plague nllghtlntj on
food, aro sufllclucnt to cause Infection.
Thero seems llttlo doubt Unt tho pneu
monic form of plaguo Is Infectious by
tho breath; nnd a nurso in Hongkong
died of plaguo In consequence of tho
sputum of n plaguo patient bcliijf re
ceived on her conjuctlvn.
It Is tho rat and mouse, and their
powers of Infecting food, etc., thnt are
tho most potent factors In the spread
of plaguo; and it is In this direction
wo must seek means for counteracting
Three to flvo dnys Is tho usual pei lod
of Incubation of plague. Larger pe
riods are reported, even up to ton days,
but the nccuracy of observation ns
regards chnnces of Infection may bo
doubtful far any period longer than
flvo days. On board ship, a five-day
voyago ought to be sufficient to guar
anteo ot immunity from further out
break. This mny bo true enough were
do rats on board, but infected rats may
cause plaguo to appear again and
again, In what seems a sporadic form,
for any length of time.
A typical attack ot plaguo is ushered
In by a severo rigor, headache, and
sudden prostration, A dry hot skin, a
dusky countenance, sunken eyes and
drawn features, accompanied by ac
tive mental '.disturbance; or a passive
the Disease When
and Indifferent manner, appear early In
till! dlsP.lSO. Ill filet. Mill HVnitltOmH
usually arc so urgent that In an hour
or two tho patient appears as If ho had
been 111 for n week. The temporaturo
may suddenly riso to 101 degrees F.
or more, or It may reach Its maximum
only after two or tnreo days, in many
cases It never rises nbovo 101 degrees
I-'., nnd it may fall to normal after a
day or two. Tho Increase of tempera
ture Is no guldo to tho vlrulcneo or
prognosis of tho disease. Tho pulso at
tho Invasion period Is usually full ami
tense, but later It falls or becomes
feeble and Irregular.
Tho rapidity with which buboes ap
pear lo at times amazing, nnd they as
sume a bugo slzo In a few bonis or, on
the other hand, mny continuo of mod
erate size (walnut) through tho ill
ness. DIGESTIVE SYSTEM.
Early In the dlseaso tho lips become
dry and cracked; tho dorsum of tho
tonguo Is covered by a thick, greylsh
whltu fur, which speedily changes to
n mahogany or almost black crust,
whilst tho tips and edges appear ab
normally red. 1 be appetite Is lost;
vomiting of n watery bile-stained fluid,
or ot coffco-ground looking substances,
occurs li regularly throughout tho Ill
ness. Constipation may rule, or may
alternate with looso dejections with or
without blood. The spleen Is always,
and the liver usually, enlarged; but
owing to tho apathetic state of tho pa
tient it Is not always possible to elicit
an expression of pain during examina
tion of theso organs.
Tho nervous symptoms In plague
may from tho first nssumo a wild de
lirious form. Unless tho patient Is
watched ho may rush to the window or
of tho mind," nnd not a distinct effort
ot tho will. Instead of nctivo delirium,
the patient may bo apathetic, listless,
expressionless, or semi-conscious from
tho first, heeding no one, nnd answer
ing questions only when partially
roused. In children, muscular twitch
Ings and convulsions nro common.
Death may occur In twenty-four
hours, but tho third of fourth day Is
tho most fatal period. Should the pa
tient survive the sixth day, there arc
hppes of his recovery.
A perusal of tho several varieties In
the tjpo of plnguo will servo to eluci
date tho fact that mistakes In Hni;uo
sls are possible. The absence of bu
boes cannot bo rolled on us ovldenco
that the dlbcaso Is not plague. On the
other bund, the writer sent a patient
suffering from high fover, vomiting,
delirium, mid acutely enlarged and
painful groin glands to tho plaguo hos
pital In tho belief that ho was suffer
ing frqm plague, to find afterwards
that his symptoms were duo to nn at
tack of filarial fever. It Is only by the
microscope, and bacteriological Inves
tigations thnt a precise diagnosis of
plaguo can bo arrived at In doubtful
QENEIIAL SANITAUY MEAol'IlES.
Tho rat. All observers agree that
tli .rut Is curly Infected by plnguo dur
ing .an epidemic. Many contend that
tho rat Is Infected before man, nnd that
the .apeparanco of dead rats about n
house forebodes tho Illness of tho In
habitant. Such being tho case, It
would appear that tho rat Is tho host
by which tho plaguo Is conveyed tr
human beings. The faeces and urlno
of plnguo Infected animals contain the
badllus jkUb, nnd .there can bjs no
uouut uut that tho dejecta of theso
Infected anlmnls. getting Into human
tooiu la Hintiejent to convey tho dis
ease. Again, a decomposing rat, dead
ot plague, will lio assailed by hosts of
Insects, which iJius becouio Infected
themselves or bervo to convoy Infect
ing media on their bodies nd limbs.
Such being tho case. It would nconi ad
visable, nay lmpertlve, that, sls a pro
phylactic measure, Uto rats In a plague
threatened community outght to bo de
stroyed beforo tbo advent of tlw dis
ease. "Stamping' 'out an epidemic of
plaguo Is an Irksome, tedious, and veil
nigh Impossible task. When plague
comes It comes "to stay," nnd Its j
curfilon ought to bo warded off at nil
hazards. Recently Manson, Simpson,
and other authorities, declared thnt tho
only prophylactic mcasuro to bo re
lied upon is tho destruction ot tho rats
whlcln. Infest ships, grain, sowers,
drains and basements.
Segregation, isolation ad dlslnfec
tlon nro tho means ndoptcd by Banltnry
uumuiuicH in ovcry pari or tno world
whon plnguo breaks out In a commun-'
lty. Tho moment a plaguo occurs In
any dwelling tho patient should be ro
moved from tho houao to a specially
constructed hospital. It is advlsablo
that this hospital should bo built ot
"temporary" materials meroly, so that
It can bo burnt when tbo epidemic Is
over or when It has bocomo foul from
long use. Tho hospital should bo just
outsldo tho town in some isolated
piece of ground, but, It the city is
lnrge. It Is unwlso to havo the hospital
tpo far removed from the Infected
area, otherwise patients may suffer
HI effects by having to bo conveyed a
long distance Persons who have been
In actual contact with the patient, and,
not-only theso but nil persons in Uie
dwelling nnd alio In tho houseaimme-
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1 dlately adjacent should be removed
nnd tho houses disinfected. Tho "con-
' innia " n, tlin nvnidnit nnmnna nrn
termed, .nro to bo qunrtercd In "camps"
specially laid out for their accommo
dation. Hero they nro medically ex
amined onco or twlco n day, and de
tained for at least seven days. Should
any of tho "contacts" In tho isolation
"camp" develop plague, tho building
Lor tent must bo ovneuated, disinfected
or destroyed nccordlng to tho material
of which it Is built. A further obser
vation period Is then necessary beforo
those remaining can bo released.
Should, howovor, tho "contacts" con
sent to vaccination by Hnffklno's pro
phylactic tho example set by tho In
dian Government may bo wisely and
safely followed namely, granting In
oculation certificates entitling tho
Holder to exemption from plnguo rules
for a period of six months.
When plaguo breaks out In a city tno
town must bo apportioned Into sanl
tnry districts, over which nn officer In
authority Is placed In charge. An un
limited supply of workers must bo ni
his disposal for searching out tho sick,
carrying tho patients to hospital, dis
infecting houses, drains and sewers.
Quarters must bo provided for (heso
men, so that they do not go back to
their homes to cat or sleep, othcrwlso
they may carry plaguo to their fami
lies. Tho officer In chargo must havo
ample powers given him ot advancing
or punishing nil thoso working under
him, nnd complete power must bo as
signed to him to deal with refractory
friends nnd relations of patients.
Even after several years' experience
of epidemics of plnguo tu dlfforcnt
parts of tho world, but llttlo advance
has been mado In the medicinal or sur
gical treatment of plague.
A symptomatic nno of treatment Is
nil that we hnvo to guldo us. Initial
constipation, nssocintcd with slight Ic
teric tint of conjuctlvno nnd skin, lr
combated oy n flvo grain dose of cal
omel. Freo purgation, should tho va
riety develop Into ono of Intestinal
type, Is not, however, without danger.
As a rule, however, It seems to do good.
Tho buboes may be poulticed, chiefly
with tho iden of relieving pain. Tho
substance of tho gland may bo Inject
ed with n minim or two of carbolic
ncld or a solution of hydrargyrl per
ehlorldum mid lodldo of potassium.
Tho cupsulo of tho gland may bo in
cised subcutnneously, or tho gland mny
bo laid open nnd treated nntlscptlcaliy.
In the hopes of stnylng the process of
glnnd necrosis. Nono of theso modes
ot treatment havo yielded any such
measure of success ns to highly recom
mend themselves. Pus when formed
should, of course, bo allowed freo
evacuation, but tho early incision of
tho glnnd meets with disfavor in tho
opinion of several practitioners. To
combat the tendency to heart failure
tho usual drugs nro indicated; digi
talis, strophanthus, musk, camphor,
carbonato ot nmmonln, and alcohol,
havo each their advocates, and each is
useful. High temperature Is to bo
treated by phcnacctln In preference to
cither nnttfcbrln or nntlnvrln ril.
rlum Is to bo relieved by sponging tho
body with warm water, com medica
tions to tno head, and hyoscino admin
A curatlvo scrum, originally intro
duced by Ycrsln in China, and now
prepared nt tho Pasteur Institute,
Paris, has been tried in China, India,
and Oporto. Except In Oporto, tho
treatment seems to havo met with but
llttlo success; but, according to Cal
mctto, tho scrum has reduced tho mor
tality In Oporto to nil.
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