PLAGUE. 84 hemorrhage, of peritonitis, of jauruiice, of hyper- pyrexia ; or he may recover alter about two iiiontlis' eoinaleseeii'ce. The biilioes often sup- purate, or heconie nec-rcitic, soiiietimes involving eonsiderable areas of siirruunilinj; tissues. Some- times foci of bronchopneumonia are found in the lungs, each focus surrounded by a congested pulmonary tissue. Occasionally the alveoli are found full of sanguinolent fluid which is swarm- ing with plague bacilli. Or, nuiltiple abscesses and imlmonary infarcts are noted. These cases in which lung involvement is prominent are called pneumonic ))higuc. I'HOONOSIS. iloHUinlTY, AND MOKTAUTY. In the vast majority of cases the prognosis of the disease is extremely unfavorable, much depend- ing on the character of dilTercnt epidemics. Sep- tica-mic and pneumonic cases are almost always fatal. After convalescence, weakness and a neur- asthenia may persist for a long period. The rate of mortality varies much. In certain en- (h'mics from one-half to three-quarters of an entire population has jierished. In the Hong Kong epidemic of 1804 the mortality was 95 per cent. In Bombay during 1896 and 1897 it was r>0 to (iO per cent., while during 1898 to 1901 it averaged 80 per cent. Pnoi'HYi^wis. As the eliminated bacilli may enter the healthy individual directly by cutane- ous infection, by inlialalion, or by ingestion (as has been abundantly jiroved), or may enter indi- rectly, by means of Hies, fleas, rats, etc.. it is evident tluit inspection, isolation, and disinfec- tion nuist be emjiloycd to prevent or limit an epidemic of plague. Among the preventive meth- ods are general hygiene, good drainage, clean water-supply, cleanliness in dwelling houses, and cleanliness of streets. Isolation of the sick must be eaily eni])loved. and infected dwellings must be thoroughly disinfected, as also wearing ap- PLAGTJE. I)arel, bed linen, etc. Formaldehvde is probably the most thorough and convenient disinfectant. Chloride of lime is recommended for disinfecting fa'i'cs, as well as for covering dead bodies of human beings, as w^ell as of all aninuils dving during an epidemic. Isolation of the convalescent must be continued, according to Kitasato, for a month after apparent recovery; for the plague bacilli are found in the blood for a period varying from three to four weeks after the cessation of all symptoms of the disease. Rigid quarantine may be necessary during an epidemic. Rpecitio prophylaxis may be employed before or during an invasion of the dread disease by means of 'Yersin's antipest serum' or "Haffkine's prophylactic fluid.' The serum devised by Yer- sin is blood serum taken from horses that have been inoculated with the plague. Hypodermic injection of the serum causes immediate im- nuniity, which unfintunately lasts only 12 to 14 days. A dilliculty in securing acquiescence in repeated injections at once arises, and as a popu- lar treatment it is umlcr a disadvantage. Haff- kine's fluid is a culture of tlif Itacillus prxtis rendered virulent by special methods, the bacilli, after abundant growth, being killed by an expos- ure to a temperature of 70° C. for several hours. Inoculation with Haffkine's fluid has the ad- vantage of conferring immunity lasting from a few days to several months. Calmette, director of the Pasteur Institute at Lille, France, states that a single inoculation of three cubic centi- meters of Hafl'kind's fluid a month old estab- lislies imnumily only after the seventh da.v and for a variable period thereafter. A great disad- vantage in the use of the prophylactic fluid lies in the facts that during immunization the person is more susceptible to plague ; and that if he already had contracted even a mild attack, the inoculation would be fatal. Authorities recom- mend the provision of antipest serum for prompt use in order to arrest an epidemic in the first cases, and tlie employment of Haffkine's fluid to inoculate the people dwelling in localities threat- ened with an invasion of the disease. Treatment. The treatment of plague has been in the past mainl.v symptomatic. Early admin- istration of calomel, followed by antipyretics, tepid sponging, alcoholic stinuilants, ether, cam- phor, annnonia, and digitalis have all been of benefit in mild cases. Incision of the bubo and ex.section of suppurating and sloughing glands have been practiced. But the best results have l)ecn olitained from the use of Yersin's serum. It has increased recoveries 15 per cent., besides being an unquestioned preventive. In Belgaum, India, in 1900-01. where a systematic test of the prophylactic was made, 61.4 per cent, was the niortalit.v. In the fall of 1899, Lord Curzon, Viceroy of India, who gave personal attention to the plague hospitals and segregation canqis, en- thusiastically advocated inoculation with Haff- kine's fluid, and set an example by having him- self and his partv inoculated, which was of great vaUie in preventing panic and in encouraging proper measures for protection. Recent Spread of the Plague. The scourge leached England in 1899, in the person of a sailor from Calcutta, who was landed at Ply- mouth. To the same port a coal-trimmer from Bomba.y was brought, suffering from plague. In England, in 1900. there were four cases, with two deaths; in 1901 there were 14 cases and 11 deaths. Eleven cases were reported in (ilasgow in 1900. with one death. New York City was reached by the plague in November, 1899. on a coffee steamer from Santos, Brazil, aboard of which two men were sick with plague on reach- ing quarantine. There was no spread of the dis- ease. In December. 1899, the fell disease ap- peared in Honolulu, Hawaiian Islands, probabl.y brought from Japan. There were four cases and two deaths. In 1900 the islands reported 84 cases, with 64 deaths; in 1901, 13 fatal cases. In 1900, of two eases reaching the port of New York, one proved fatal in quarantine; in 1901 a stoker on a steamer from Calcutta appeared at quarantine as a case of plague. Undoubted bu- bonic plague was uncovered in November. 1900, in the Chinese quarter of San Francisco, and a large area was declared infected. Great ditficult.v was experienced by a special commission which ex- plored this quarter, and which finally reported in 1901 that there had been in all 42 fatal cases of the plague in San Francisco. Manila, P. I., furnished a few cases of plague in 1899, and in 1900 there were 399 eases, with 281 deaths, reported from the Philippines ; while in 1901 the figures reported were 497 cases, with 375 deaths. The United States Marine Hospital Service prepares at its hygienic laboratory a quantity of the prophylactic fluid of Haffkine, for distribu- tion to national. State, and local quarantine of- ficers throughout this country. The Pasteur In-
