IV. Internal.—Knowing as we do that the plague is due to the toxic products metabolized by a pathogenic bacillus, the question comes—would an antiseptic treatment be of any use? Can we by any means induce an antiseptic action on the blood, or have we any drug which can act as antitoxin? It must be at once stated that no drug that has been tried yet fulfils the above conditions. The claims of quinine, however, should be taken into account. This drug in small repeated doses acts as a general antiseptic. I would, therefore, advocate its use especially in the early stages. Plague is a disease in which collapse sets in early and cardiac asthenia is a very early complication. There is, therefore, great urgency for early stimulation. Alcohol may be given freely, but at the same time it must be remembered that if the organs of elimination are not acting properly, alcohol may do harm. For their stimulant effects whiskey or iced champagne may be given. Carbonate of ammonia or spirit ammonia aromatic are held to be very useful stimulants in plague cases. They may be given in combination with cinchona, digitalis and ether. A prescription like the following may be useful:—

Ammonia Carb. 5 grains.
Chloric Ether 20 minims.
Sulphuric Ether 15 ”
Tint. Digitalis 5 ”
Tint. Cinchona 1 dram.
Aquæ Camphor 1 ounce.
Every three hours.

For cardiac asthenia, the following may be tried:—(1) Caffeine, hypodermically, 5-grains dissolved by the aid of 5 grains of Sodium Benzoate in 20 minims of warm distilled water and injected three or four times a day if needful; (2) Ether or ethereal solution of camphor hypodermically; (3) Strychnine, hypodermically, beginning with gr. 1/60 every four or six hours till gr. 1/16 is injected, or Liquor Strychnia in 5—10-minim doses every four hours; (3) Musk may be given in 5-grain doses, or as in the following mixture:—

Pulv. Moschi 10 grains.
Mucilage Acacia 2 drams.
Syr. Aurantii 2 ”
Aquæ Camphor ½ ounce.
To be given every 6 hours.

Digitalis does not always give good results, a fact which Lowson attributes to some inflammatory or fatty degenerative changes in the small vessels giving rise to a tendency to hæmorrhage. Stropanthus may be substituted. Transfusion of blood a hot saline solution and inhalation of oxygen have been recommended for collapse. Dr. Viegas of Bombay recommends Liquor Hydrasgyie Perchloride 10 to 15 minims every four hours if there is no albumen in the urine. Dr. Dimmock has advised subcutaneous injection of Guaicol 10 or 15 minims every two hours. Permanganate of Potash 5 to 12 grains in 24 hours has also been recommended. Dr. Blaney has recommended Medritina in two-dram doses every two hours when the kidneys are involved. Camphor has been recommended by some as a cardiac stimulant.

TREATMENT OF SYMPTOMS.

(1). High temperature may be reduced by antipyretics, such as antipyrin, phenacetin, antifebrine, &c. These drugs produce profuse perspiration and a certain amount of depression; it is, therefore, advisable to restrict their use during the first few hours only, and if not found responding, they should be dropped altogether. Pyrexia is but a sign of the intensity of the activities of the infective agent, and by artificially reducing the body heat we really do not lessen the virulence of the poison, as shown by the rise of the temperature again as soon as the action of the antipyretic subsides. Hyperpyrexia itself is, however, an injurious symptom, and when there is long continued high temperature it is necessary to reduce it, either by an antipyretic, quinine or cold bath, or cold sponging. Cold bath is not suitable in plague patients on account of the movement of the body which it entails, and also on account of the serious cardiac depression which accompanies the disease. Two grains of phenacetin with 1 grain of hydrobromate of quinine is a safe antipyretic. Brandy and tepid sponging are also very useful.

(2). Brain symptoms.—For headache a mustard plaster behind the upper part of the neck and over the occiput. Ice cap or Lieter’s tube or plain water should be applied over the temples and scalp. Nervine sedatives, such as Potassium Bromide, may be given for insomnia when there is not much depression. Otherwise full doses of alcohol may be tried. Opium should not be used, but in mild cases, without great depression, 10 to 20 minims of Liquor Opii sedativus with 30 minims of Sal Volatile in an ounce of camphor water may be given to soothe nervous unrest. For insomnia Lowson speaks highly of Morpinæ gr. 1/8 to gr. ½. Hyoscine gr. 1/200 to gr. 1/75 may be tried. Meningites should be treated by cold to the scalp and counter-irritation to the nape of the neck and occiput.

(3). Hæmorrhages may be treated by Ergot or Ergotin internally or hypodermically. When there is much hæmorrhage, use of alcohol should be partly suspended.

(4). If there is constipation, a dose of calomel may be given. In the beginning there is almost always constipation, which should be removed by a dose of calomel followed by a saline. Diarrhœa may be checked by an enema of opium. Two grains of Dover’s powder and 10 grains of tannin mixed with an ounce of gum mucilage and with two or three ounces of warm water, arrowroot or starch may be used for injection. Salol in 10-grain doses every 4 hours may be given for diarrhœa. For vomiting and hiccough sinapism over the epigastrium, sucking of ice, and for thirst acidulated water with syrup of lemon are recommended. Coma must be promptly met by cold effusion if there is pyrexia or by rectal injection of strong coffee. The bladder of the patient should be carefully watched. Pneumonia and other complications should be treated under general principles.