Plague / Its Cause and the Manner of its Extension, Its Menace, Its Control and Suppression, Its Diagnosis and Treatment

by Thomas Wright Jackson

The statement that the prognosis in all cases of septicæmic plague is hopeless is not confirmed by my experience.

It should also be remembered that primary pneumonic plague and secondary pneumonia developing in the course of systemic plague are quite different in their significance and mortality, primary pneumonic plague being well nigh invariably fatal.

Pathologic Considerations.—Only the student of plague pathology, who has seen a large number of complete autopsies, can understand how universal is the involvement of organs, glands and tissues in systemic plague and how widespread is the distribution of B. pestis throughout the body, and he will best understand how treatment, to be in the least effective, must be given in the very earliest hours of the disease.

Plague is an exquisitely septicæmic disease and this fact must never be lost sight of by the therapeutist, who must realize that from the earliest moment of infection all plague is septicæmic plague.

Treatment, Conditions and Prognosis.—Passing to the subject of treatment let us, first of all, admit that even under the most favorable and approved conditions of treatment the mortality is extremely high. On account of the delay which usually occurs in the recognition of plague,—a delay which in the natural order of things is and must be the rule rather than the exception, because of the rapidity of onset of the disease and the fact that it occurs much more frequently in the lower social classes than elsewhere,—no brilliant results are to be expected from any plan of treatment.

The matter of plague treatment is far from being in the same satisfactory state as the matter of preventive control. I do feel, however, that biologic treatment from the earliest possible moment, with serum, is of the greatest promise, however discouraging the general prognosis may be in plague.

Serum Treatment.—Recent writers agree that there is no treatment with curative value except that with antipest serum. To this belief I subscribe assent, as I find it entirely in accord with my experience and that of my colleagues in Manila during 1912–1914.

Holding this view, I can see no reason for repeating here the details of purely symptomatic treatment. Symptomatic treatment has for its object the securing of comfort and of relief from suffering for the patient and is highly proper in its place, remembering always that it is not curative and that if employed alone it is worse than inadequate.

Symptomatic Treatment.—Opiates (morphine by needle) for pain, delirium and excitement; application of ice bags and cold or tepid sponge bathing for high temperature; stimulants for heart weakness, are all indicated and are required in nearly every case of plague.

As a rule surgery is not called for nor appropriate, except in cases which develop secondary surgical conditions, which conditions we need not consider at this time.