TREA TMENT-^PROPHYLA XI S 



oculated with serum. Several such cases have been recorded by 

 Darling. The serum may be given also by intravenous injection. 



Yersin's serum is prepared by the inoculation of horses with 

 fresh agar cultures, and is such that o«i c.c. should protect a mouse 

 from a dose of bacilli, which otherwise would kill it in two to three 

 days. The dose for man is 60 to 300 c.c, given intravenously and 

 also subcutaneously near the buboes. Lustig and Galeotti's serum 

 is prepared by injecting a horse with a vaccine which contains 

 nucleo-proteid from cultures. The mode of action of these sera is 

 said by some not to be bactericidal, but to encourage phagocytosis. 



Though admitting that the serum treatment is far from being 

 perfect, we advise its use at the very beginning, as it gives somewhat 

 better results than the ordinary symptomatic treatment or the 

 so-called antiseptic treatment, such as the internal administration 

 of carbolic acid. 



As regards the symptomatic treatment, the first indication is to 

 keep the patient in bed, because of the danger of syncope, and to give 

 him good nursing and fresh air. Fever must be treated by sponging 

 and cool or cold applications; buboes by cold applications and 

 ichthyol, and when they suppurate an incision must be made and 

 the wound treated a.septically. Not much good is to be obtained 

 by excising the glands even in an early stage, though several 

 authors — e.g., Terni — have recommended it. The heart's action 

 must be maintained by digitalis, strophanthus, and strychnine. 

 Restlessness may require a hypodermic of hyoscin; haemorrhage 

 will require treatment by calcium chloride; the so-called car- 

 buncles must be treated ant iseptic ally ; pneumonia and bron- 

 chitis require the ordinary treatment ; and if there is constipation, 

 calomel and a saline purge may be given; while vomiting is to 

 be treated as described under Malaria. A sufficiency of fluid should 

 be given, so as to keep up the action of the kidneys. 



The diet should consist of broths and milk, while stimulants are 

 usually required. 



Tincture of iodine has been recommended, and is given by oral administra- 

 tion, a few drops at a time, diluted with cinnamon water, and may be given 

 also by intravenous injection, 5 to 7 minims once or twice daily. Eusol has 

 been recommended by Brayne. 



Prophylaxis.— Bac?7/ws pesli^i being conveyed by the rat -bite from 

 rats to man as a rule, and more rarely from man to man, it is 

 obvious that prophylaxis must include methods directed against 

 rats and fleas, and methods for the protection of human beings. 



The spread of the disease from place to place is thought to be 

 mainly by the flea being carried by human beings on their person, 

 or in their clothing, or by means of the merchandise, or by rats. 



The prophylaxis will be considered under two headings — Public 

 Prophylaxis and Personal Prophylaxis. 



Public Prophylaxis. — It is necessary, in order to prevent a 

 country from being infected with plague, to institute a Sanitary 

 Service, which should consist of a central authority for collecting 



