Plague: Its Cause and the Manner of its Extension, Its Menace, Its Control and Suppression, Its Diagnosis and TreatmentJackson, Thomas Wright
History
Plague: Its Cause and the Manner of its Extension, Its Menace, Its Control and Suppression, Its Diagnosis and Treatment
Jackson, Thomas Wright
Plague; Rats as carriers of disease
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.
STATISTICAL STUDIES IN MORTALITY.--The statistical study of plague
mortality from the point of view of treatment is misleading and
unsatisfactory for reasons already given in our discussion of
treatment, viz.: failure to secure early recognition and early serum
treatment, and the greater incidence of plague in the lower social
classes.
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