Page:Tropical Diseases.djvu/400

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358
PLAGUE
[CHAP.

to the epigastrium are also useful. Later, when the pulse begins to fail, the same authority recommends strychnia, with or without carbonate of ammonia, in preference to digitalis or strophanthus. Strychnia, he says, should be used as a routine treatment, and commenced early in the disease. In collapse, stimulants of various kinds, including strong ammonia to the nostrils and ether hypodermically, are indicated; they sometimes succeed in resuscitating a sinking patient. Given with judgment, Lowson found that morphia was by far the best hypnotic. At the commencement ⅛ to ½ gr. hypodermically relieves suffering and procures sleep; later, ⅛ gr. suffices. Hyoscine (1/200 to 1/75 gr.) or chloral (20 gr.) and bromide of potassium (30 gr.) are of service for the same purpose. Diarrhœa, if urgent, is best treated by intestinal antiseptics, as salol in 10-gr. doses every four hours. The buboes in the early stage may be treated with applications of glycerin and belladonna. Should they become red and inflamed they must be poulticed and, on softening occurring, incised and dressed with iodoform. Indolent bubonic swellings should be treated with iodine liniment. Feeding and stimulation are to be conducted on ordinary principles. In the Manchurian epidemic intravenous injections of salvarsan were tried without effect.

Serum-therapy.— Yersin, Calmette, and Borrel have shown that intravenous, intraperitoneal, and subcutaneous injections of gelatin cultures of plague bacillus mixed with a little bouillon and heated for one hour to 58° C., if employed in doses just short of producing a fatal issue, and repeated three or four times at intervals of fifteen days, render rabbits immune to the plague bacillus. The heating kills the bacillus but does not destroy its toxins, which at first give rise to a very smart but, with each repetition of the injection, diminishing reaction. They further found that the serum of an immunized animal, if injected into an unprotected rabbit, exercised both an immunizing and a therapeutic influence. An unprotected rabbit was inoculated with a virulent culture of the bacillus, and twelve hours afterwards with