150
The result of experience gained by local, radical or tentative treat-
ment of the glands does not lead one to expect much benefit from there.
That abscesses should be opened when they point, or when fluctuation
is perceptible, is, of course, natural; but that local remedial steps should
be undertaken for the purpose of affecting the course of the disease by
acting on the gland is, from what we know of the pathology of the
disease, scarcely rational. Injection of a swollen gland when it is
accessible, as in the groin, with such substances as carbolic acid, per-
chloride of mercury, or a solution of the perchloride of mercury and
iodide of potassium, has perhaps a theoretical basis of justification, but
practically little good can be ascribed to it. The latter-mentioned
solution may have a higher claim, as in several cases in which it
has been administered temperature falls and the patient seems easier.
It may be, however, that the mere pricking of the tense capsule of the
gland, even by needle punctures, may serve to relieve tension and
thereby pain. This leads one to the belief that subcutaneous incision
of the gland may be attended with beneficial results, and it is a method
of surgical procedure not without precedent. Early free incision of the
gland is not to be recommended, nor can excision be in any way
justified. The disease is a polyadenitis, and of so extensive a nature
that eradication of infected glands is an impossibility. A gland when
swollen, red and painful may be smeared with glycerine and belladonna
or poulticed to relieve pain, and when fluctuation is perceptible it should
be opened, but further procedure is useless. When pus is evacuated,
dusting the wound with iodoform and ensuring thorough drainage are
the means by which the best results are obtainable.
    Retention of Urine, a frequent concomitant during the delirium  of
plague, renders the use of the catheter imperative."
                 (G.O, No. 298-M., dated 26th February 1897.)

  2. Extract from the Report of Major Bannerman, M.D., B.S c.,
                      dated 27th March 1897.
    "It is necessary that a medical officer should be able to recognise at
the earliest possible date the occurrence of a case of plague, both for the
sake of the patient himself, and for the prevention of the spread of the
the infection. In cases presenting the classical signs there can be
little difficulty in arriving at a correct diagnosis, but when the glan-
dular swellings are absent, as they often are, it may be necessary to
keep a patient under observation for some days before a decision can be
arrived at.
    The following signs and symptoms may be regarded as typical :-A
 rise of temperature on the first day of the disease, of a very pronounced
 character, 106° or more being common, accompanied by severe shivering
 and frequent vomiting. In 95 per cent. of the cases the conjunctivæ
 are found to be injected on the second day of the disease. The tongue
 may be described as being like wash-leather, or of a rusty brown
 " typhoid " appearance, with red or even inflamed edges. When spoken
 to, the person answers in a slow hesitating indistinct manner, the sylla-
 bles being separated from one another, and the impression conveyed
 being that the individual is under the influence of alcohol. The gait is
 also in many cases suggestive, being like that of a drunken man. Some
 cases, on the other hand, may present violent maniacal symptoms, or the