Treatment of the Bubonic Plague.

Those of us in the interior of the United States have had but little, if any, experience in the treatment of the bubonic plague. In my examination of the literature on the disease I long since concluded that we have a remedy in echinacea, which, if supported by other remedies indicated in each individual case, should combat the disease with reasonable success.

One of our physicians on the west coast presents the following in The California Medical Journal as the treatment he has carried out with a number of patients during the past few years, with fairly successful results.

After writing fully of the first bubonic manifestations and the abscesses, he says:

"We may have in addition to the glandular abscesses, carbuncles on the lower extremities, the hips or even on the neck of the patient. In the pneumonic form we have the usual symptoms of pneumonia, the chills, fever, severe pain in the side, cough, rusty sputum and the physical signs of consolidation. The earlier the case is seen, the quicker diagnosis is made, the more successful the treatment which we are going to attempt to outline. We wish to emphasize the following points:

The intense weakness or prostration, the fever, the petechiae or vibices resemble typhus fever. Remember no known fever is characterized by as severe prostration. The glandular abscesses and the carbuncles are distinctive, although they are said to be sometimes absent in the milder cases of a declining epidemic, as well as in the fulminant form of the disease or pestis siderans, as some style it. The Diazo reaction of the urine is usually absent. According to various standard authorities this disease is said to be the most fatal of all disease expressions.

I will now undertake to elucidate a treatment which I believe from my experiences with stray cases from 1894 to 1900 and with sporadic cases occasionally coming under my care from time to time up to date, has proven eminently successful.

"First: During the period of extreme prostration, or more plainly, intense weakness in all cases, administer hypodermically a solution prepared as follows:

Resublimed phenol, C. P. 4 grs.

Aqua pura . oz. 1

M. Sig. dr. ss., hypodermically; repeat in six hours if necessary; the apportionment to be administered should be warmed nearly to the temperature of the body of the patient, or if subnormal to 98.6° F. and applied by the infiltration method. Merck's phenol is our preference.

Echafolta dr. 2

Aqua pura, q. s . oz. 4

M. Sig. Teaspoonful in water every thirty minutes during this period of weakness. If there is a prodromal condition intervening before the chill and febrile reaction administer during the prodromal period:

Alstonia constricta, pulv dr. ss

Quinia, sulph dr. ss

We prefer Lloyd's powdered alstonia, the bark of the Australian fever tree.

M. Sig. In five-grain doses in capsules every hour in alternation with:

Aconite, spec . drops 15

Aqua pura oz. 4

M. Sig. One dram every hour in alternation with the alstonia compound, provided we have the small, frequent, wirelike pulse, or we would use:

Spec. veratrum drops 30

Aqua pura oz. 4

M., Sig. One dram every hour in alternation with the alstonia compound if the pulse is full and bounding, or,

Specific baptisia dr. ss

Aqua cinnamoni, q. s . oz. 4

M. Sig. One ounce every hour in alternation with the alstonia compound, provided the tongue looks like tainted beef and the pulse is like a muddy stream, full and oppressed; or,

Rhus tox minims xv

Bryonia minims 15

Aqua, q. s . oz. 4

M. Sig. One dram every hour in alternation with the alstonia compound if the fungiform papillae on the edges of the tongue are prominent and there are indications pointing to inflammatory processes in serous membranes as the pleura, or later in the disease if synovitis is a complication.

Bryonia dr. ss

Cactus dr. 1

Aqua, q. s . oz. 4

M. Sig. Teaspoonful every hour to effect, then every six hours.

One thing is sure, during the prodrome the alstonia and quinia compound is the remedy to administer with whatever other indicated remedy the physician in his judgment may see fit to give.

The glandular abscesses we incise freely, thoroughly cleansing same with peroxide of hydrogen. Then irrigation freely with Lloyd's asepsin, thirty grains to a quart of water at a temperature as near the normal temperature of the body as practicable. Then dress the wound with Merck's dry pulverized oxyiodide of bismuth. Dress the wound once daily as above; it will heal. The carbuncles which are often present should be treated as follows:

Phenol, resublimed dr. 2

Echafolta dr. 2

M. Sig. Ten to fifteen minims injected into each of the sinuses which make up the multiple core of the carbuncle, or,

Metallic iodine dr. 2

Alcoholis, 95 per cent dr. ss

M. Sig. Five to ten minims of the above injected into each sinus of the multiple boil or carbuncle.

Use a hypodermic syringe for the above work, carrying the needle to the bottom of each sinus to make sure that it is well filled with the fluid. Then dress the wound with Mayers' ointment or echafolta cream, or compound zinc ointment, U. S. P., until the core sloughs. In cases of threatened hemorrhage of the bowels we recommend the following :

Spec. med. cinnamon dr. ss

Dest. hamamelis dr. 2

Sub. nit. bismuth dr. 4

Aqua dest . oz. 8

M. Sig. Tablespoonful every half hour.

As a matter of fact the above administered in all cases during the period of intense thirst which often appears, proves an excellent aseptic procedure.

The following assists materially in causing absorption of consolidation areas in the pneumonic variety:

Spec. cactus dr. 1

Spec. jaborandi dr. ss

Aqua q. s oz. 8

M. Sig. One dram after meals thrice daily.

Spec. berberis aquifolium dr. 1

Spec. rumex dr. 2

Stillingia dr. 1

Aqua q. s . oz. 8

M. Sig. One dram before each meal thrice daily in half glass of water.

Of course food, hygienic measures, cleanliness about the person and their surroundings are vitally essential. I am of the belief that half-dram doses of echinacea every two or three hours throughout would be of much service.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.