Symptoms.—Both forms of plague are characterised by sudden onset, sharp fever, giddiness, great weakness, a drunken gait, appearance and speech, and a tendency to heart failure.
In bubonic plague there is lassitude, headache and shivering, and the face is pale and anxious. The patient looks haggard, his eyes are often bloodshot, and his expression is frequently one of fear or horror. His temperature runs up to 102°, 104° F., or even higher, and his face gets hot and flushed. There is intense thirst, the tongue becomes dry and brown, the urine is scanty, and there may be delirium. About the second or third day the glandular swellings known as buboes make their appearance, usually in the groin, but they may occur in the armpits, the neck, and elsewhere. As a rule there is only one bubo, which varies in size. There may be a good deal of pain associated with the swelling, and sometimes it is very severe. The bubo, if not dealt with surgically, eventually softens and bursts, discharging matter and sloughs. In cases which are going to recover, improvement is noted about the fourth or fifth day, and is heralded by a profuse perspiration. In fatal cases, death usually takes place between the third and fifth days.
Pneumonic plague usually begins with shivering and vomiting. There is a cough, accompanied by breathlessness and blueness of the face, the sputum is profuse, watery and blood-stained, and as it is full of plague bacilli it is exceedingly dangerous. Very few cases of pneumonic plague recover.
Prophylaxis.—Ward off attacks of fleas. A substance called pesterine is good for this purpose, and consists of kerosene 20 parts, soft soap 1 part, and water 5 parts. Powdered naphthalene and tricresol powder are useful. Attendants on plague patients should be protected from infection. They should wear puttees or gum-boots, gloves, and overalls, and those looking after pneumonic cases must wear masks, goggles, and overalls. There is a protective vaccine for plague, and those travelling in districts where plague is epidemic should avail themselves of its protective power.
Treatment.—The only treatment which is of any value, and this only in bubonic plague and when given early, is the administration of plague anti-toxin, which should only be given by a medical man. The symptoms should be treated in order to relieve the patient’s distress. Belladonna and glycerine may be applied to the buboes, and they should be opened and carefully dressed once suppuration is established. Morphia is often required for the restlessness and insomnia, and cardiac stimulants are indicated in nearly every case.
Pleurisy, or Inflammation of the Membrane Covering the Lung.
This is more a disease of cold climates, and is usually the result of chill following severe exertion.
Symptoms.—Pleurisy is accompanied by less fever and general sickness than pneumonia; its characteristic symptom is the “stitch in the side”, which always accompanies it. There is also a short, dry cough, without expectoration, which the patient tries to restrain, as it “catches” in the side, and causes acute pain. For the same reason the breathing is shallow, as any attempt to draw a deep breath causes extreme suffering.
Treatment.—The patient suffers greatly, therefore in the early stages treatment must be directed to the pain. If leeches are procurable, the application of half-a-dozen to the painful region of the chest is advisable. Mustard leaves or poultices should be applied over the part, or it may be painted with tincture of iodine; opium may be given to relieve the acute pain, in the form of Dover’s powder, fifteen grains three times a day. Five grains of quinine may be given twice a day.