June 1907.] 



407 



Miscellaneous. 



frequency in all epidemics, and I think that perhaps the safest dictum I can give 

 you as a working and standing order is this, " isolate all cases of high fever " which 

 is accompanied by marked depression, or giddiness, or " constant cough," and try 

 not to mistake a plague case for a drunken coolie, the symptoms frequently resemble 

 each other, but the severe fever must settle the diagnosis for you. The diagnosis 

 should be confirmed microscopically by Dr. Bell's method (Hong-Kong). 



The incubation is laid down at three to eight days, but instances in which 

 infection has occurred from clothing, and after months, have been observed. 

 Initial symptoms are shivering followed by severe fever, headache, vomiting, 

 unsteady gait, depression, enlargement of some of the glands (if of the bubonic 

 type). Little children usually succumb. Plague patients are infectious for about 

 one month after recovery. Rats are known to disseminate plague. Infection may 

 take place through wounds and scratches, and also through the bites of insects, 

 e.g., rat-fleas, bugs, and perhaps mosquitoes. The excreta and sputum are infective. 

 Attendants upon plague cases should wear shoes. Through disinfection of all 

 clothing (if it be not possible to burn it) is imperative. An anti-rat crusade is 

 advisable early in the epidemic. Quarantine should extend to ten days unless 

 the medical officer relaxes this rule for good reasons. Oyllin is said to be the best 

 disinfectant, Haf tkine's plague serum has been variously reported upon. 



Cholera — Frequently commences as a simple painless diarrhoea, but may 

 start very suddenly during the night, the diagnosis— in the event of cholera existing 

 in the vicinity— of all cases of diarhoea, must be guarded, and when under such 

 circumstances, such cases occur, isolation, prompt and efficient is strongly to be 

 recommended. 



The next stage is one of collapse from which many cases never recovery 

 the motions at this period become like rice-water, cramps occur, and no doubt 

 about the diagnosis usually remains, more especially if the disease has been reported 

 from the nearest town or village. 



The vehicles of infection are water, milk, and contaminated food, and 

 clothing. I found, however, when dealing with the disease in Pahang in the year 

 1901, that a grave suspicion fell upon the river fish, and whether " post hoc " or 

 " propter hoc " the disease certainly abated rapidly when I got the " kathis " to 

 place the river fish under a " pan tang," thus preventing their use as food. 



During the stage of collapse stimulants are administered by the mouth (if 

 retained) and by hypodermic medication, the application of heat, mustard plasters 

 and such like remedies also. Contact with the discharges must be avoided, and 

 disinfection carried out thoroughly if such contact occur. The vomited materials, 

 the urine, and saliva are infective, and of course the motions. 



The most prompt isolation of all diarrhoea cases in the event of cholera being 

 present in the district is necessary. If possible, change the water supply at once, 

 examine the food supply and milk supply, and destroy all articles of doubtful 

 virtue (except human beings) on the estate or works at once. Vomiting is usually 

 severe in cholera cases and is usually a pale watery fluid. The appearance of a 

 cholera patient is most typical, the hollows round the eyes, the dazed or hunted 

 appearance taken together with loss of voice, coldness of the extremities, a feeble 

 pulse, deep collapse, and the macerated appearance of the hands all lead one 

 rapidly to the correct diagnosis. 



All wells should be submitted to the permanganate process (see above) 

 which is highly praised, but I personally prefer to rely upon boiling. Corpses 

 should— failing burning— be buried with chloride of lime. Perhaps the best and 

 simplest drugs to administer in the first instance are castor oil, chlorodyne, and 

 brandy (half an ounce of the oil, 25 drops of the chlorodyne, and about one ounce 



