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Ready method of diagnosing plague.
The signs and symptoms of plague and the features of each type being thus-
capable of early recognition, a summary can be made of the ready methods of
diagnosing a case of plague of three or four days' duration (at which period the cases
usually come to light) and directions were given in accordance with them to the
Justices of Peace, Chief Constables, and others working under the Medical Officers of
the Committee's staff. The instructions were very useful in saving the time and
strength of the doctors, as the search parties would have often called upon them
unnecessarily, since no case could be taken to the hospital without being seen by a
doctor first. Enquiries should be carefully, quietly, and judiciously made on the
main characters of the disease from the friends and relations of the patient,
and-if he is conscious-out of his hearing, as the terror incidental to the disease
may be increased and the dangers of emotional distress thereby added to. We
should thus discover that the onset was sudden, characterized by high fever,
preceded by a shivering fit ; the whites of the eyes are congested ; the pulse is quick
and can be easily stopped by the pressure of a finger ; the tongue is furred white, or
yellow, and red and bright at the tip and edges ; the expression is dull and list-
less ; the speech is thick and indistinct ; there is loss of power in the limbs, or the
hands will not perform the usual movements with accuracy, and the patient fumbles
over them. There is swelling of the glands in some of the regions or groin, the
armpit or the neck, and these swellings are very tender ; there is nausea and vomit-
ing and the bowels are constipated.
If there are no glandular swellings, there is cough with expectoration, and the
general symptoms are suspiciously like those of plague ; if there are diarrhœa, vomit-
ing, abdominal distension and pains in the loins, but there are no swellings or cough,
and even if there are only some of the general symptoms present, the case should be
kept under careful observation until it has been diagnosed by an expert.
The convalescence of plague patients is often very protracted, and even for a con-
siderable time after recovery there is great danger lest any unwonted exertion should
cause sudden failure of the enfeebled heart's action. In cases that recover quickly, the
patient's condition begins to improve after about a week, and in a fortnight he is fair-
ly well. The sequelae are dimness of vision ; panopthalmitis, sometimes leading to
sloughing of the cornea and blindness, suppuration of various glands, boils, anĉmia,
great debility and emaciation, nervous symptoms, such as aphasia, dementia, partial
paralysis, especially of the lower extremities, and in other cases a condition of general
partial peripheral neuritis which lasts for a considerable time.
Treatment.
It is difficult to recommend any particular line of treatment with confidence, for it
is often seen that a plan of treatment which succeeds in one case totally fails in another.
It may be shortly summed up as nutritive, stimulant, antiseptic, antipyretic, and
local.
The general treatment is directed towards checking the development of the virus
as far as possible, keeping up the strength of the patient to the utmost, and treating
various complications as they arise. Rest, careful nursing, quiet, dieting and good
sanitary conditions are most essential as a basis of treatment. Plague patients must
invariably be treated in large airy well-ventilated rooms, quite free from overcrowding,
which must be kept scrupulously clean. The great error in the management of
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