=Treatment.=—It may be stated that the only treatment which has any curative value is that with antiplague serum. This would appear to be of considerable value in bubonic plague provided it is administered in the first day or two of the disease. It must be given in large amounts, from 50 to 100 cc. or even to the extent of 250 cc. Then too such enormous doses apparently require to be repeated. Intravenous administration gives a better chance for success in desperate cases. In septicaemic and pneumonic plague the use of serum has been without result. Salvarsan, as might be expected, has been tried but did not prove of any value. Connor has reported success with the intravenous injection of one dram of a dilution of 1 part of tincture of iodine in 10 parts of sterile water. He gave 6 such injections to a severe case with good result. In the way of symptomatic treatment one should use ice-bags to head and cold sponging to the body. Morphine seems to be the best drug to calm the patient. Cardiac stimulants, especially strychnine, are indicated for the heart weakness so much a feature of plague. Some consider incision or enucleation of the bubo of value in treatment but it has always seemed to me that the going into the periglandular exudate might serve to set up a septicaemic condition when otherwise it might not supervene. CHAPTER XIV TULARAEMIA DEFINITION AND SYNONYMS =Definition.=—This is a plague-like disease of various rodents, transmissible to man, caused by an organism _Bacterium tularense_, which is not closely allied to any other species. A number of human cases have been reported from Utah, where the disease is prevalent among the jack rabbits, and the transmission to man is through the bite of a horsefly, _Chrysops discalis_, which has previously sucked the blood of infected jack rabbits. The site of the bite in man is usually marked by a punched-out ulcer, which is associated with swelling and suppuration of the glands draining the area. The general symptoms are sudden onset, with rigors, followed by an irregular fever of three or four weeks’ duration and by a prolonged convalescence. Several cases have been reported in the middle west due to handling infected rabbits. There have been a number of infections in laboratory workers where the local signs have been absent. In man death rarely results from the disease. =Synonyms.=—Deer-fly fever (in man). Plague-like disease (in rodents). HISTORY AND GEOGRAPHICAL DISTRIBUTION =History.=—In 1911 McCoy and Chapin discovered the _B. tularense_ in a plague-like disease, first described by McCoy in the California ground squirrel. They described the organism, succeeded in cultivating it on special media, transmitted the infection to various rodents by feeding, nasal inoculation and injection of infected blood, and demonstrated the probable natural mode of transmission by the squirrel flea.